Skip to main content

Full text of "I signed as the doctor : memoir of a cancer doctor surviving cancer"

See other formats


3 9999 06384 040 7 

i oiuNED AS 

Memoir of a Cancer Doctor Surviving Cancer 

Healing through humor, hats, and hope 

UU*4A vJUwwi*! MD. 



Praise for Dr. Laura Liberman's I Signed as the Doctor 

"A lucid look at cancer when an eminent doctor becomes a 
patient. Laura Liberman's touching personal and expert 
professional insights, humanity and down-right helpful advice 
should be read by those who have cancer and those who treat 
this disease. Actually, it's a great read for everyone." 

-Barbara Goldsmith, bestselling author and historian, 
Winner of 2007 American Institute of Physics Best Book 
for Obsessive Genius: The Inner World of Marie Curie 

"When a reader laughs and cries at the same time, that's a sign 
of a great book. Laura Liberman's true story does it. I love / 
Signed as the Doctor! It made my heart sing." 

-Ellen Daniell, author, Every Other Thursday: Stories and 
Strategies from Successful Women Scientists 

"Music and medicine are healing arts. This memoir of a doctor 
facing her cancer with resilience persuasively describes music's 
potential for spiritual uplift and for synergy with medicine to 
heal the body and mind." 

-Richard Kogan, M.D., psychiatrist and concert pianist; 

creator of DVD series, Music & The Mind 

"Laura Liberman makes the extraordinary possible. The author 
inspires by her openness and sharing of perspectives. 
Particularly compelling are her images of family life, reordering 
priorities, calmness during treatment, and insights into pain 
control. / Signed as the Doctor will help patients cope with 
illness and will help physicians be better doctors." 

-Kathleen Foley, M.D., neurologist, Pain & Palliative Care 
Service, Memorial Sloan- Kettering Cancer Center 


Memoir of a Cancer Doctor Surviving Cancer 

Copyright © 2009 Laura Liberman 


ISBN- 13: 978-0-9822590-0-9 

ISBN- 10: 0-9822590-0-X 


I SBN- 1 3 : 978-0-9822590- 1 -6 

ISBN- 10: 0-9822590-1-8 

All rights reserved. No part of this publication may be reproduced, 
stored in a retrieval system, or transmitted in any form or by any 
means, electronic, mechanical, recording or otherwise, without the 
prior written permission of the author. 

Printed in the United States of America. 

Library of Congress Control Number: 2009900330 

This book does not provide medical advice such as that obtained in a 
direct consultation, and does not replace it. No recommendations 
regarding diagnosis or therapy are being made in this book by the 
author or by Memorial Sloan-Kettering Cancer Center. Medical 
issues that concern readers should be addressed directly with their 
health care practitioners. 

About the cover: 

The cover photos were taken by master photographer Richard I. 
DeWitt with permission of milliner extraordinaire Christine A. Moore 
( The front cover photo depicts 
Laura in Christine's New York studio, trying on hats as she did before 
beginning chemotherapy., Inc. 


Memoir of a Cancer Doctor Surviving Cancer 

Laura Liberman, M.D. 

Digitized by the Internet Archive 
in 2013 


This book is dedicated to my husband and the love of 
my life, David, and to our amazing two children, who make 
every day joyous. I thank the incredible Jennifer Menell, my 
"gentle reader," and Cynthia Thornton, my guardian angel. I 
offer my work to all people living with cancer or other illness 
(either personally or in a loved one), whether recently 
diagnosed, in treatment, or survivors. This book is for us. 


Foreword xi 

Chapter 1: Getting Ready 1 

Chapter 2: Telling the Kids 14 

Chapter 3: Treatment Begins 25 

Chapter 4: Celebration 38 

Chapter 5: Hats and Silver Linings 54 

Chapter 6: First Admission 70 

Chapter 7: Home 84 

Chapter 8: Reaching Out 95 

Chapter 9: Blurry Vision 109 

Chapter 10: Good News, Bad News 125 

Chapter 1 1 : Test Results 132 

Chapter 12: More Birthdays 160 

Chapter 13: Chemo Ends 177 

Chapter 14: How to Cope with Cancer: Lists 195 

List 1 : For Those with Cancer & Their Loved Ones 195 

List 2: Suggested Reading 197 

List 3: Suggested Music, Listening & Viewing 200 

List 4: Advice to Doctors 204 

Afterword 205 

Characters (in alphabetical order) 212 

Glossary of Medical Terms 215 



After I had been a radiologist at Memorial Sloan- 
Kettering Cancer Center in New York for 17 years, I developed 
left arm numbness, heaviness, and loss of dexterity. I consulted 
a neurologist and had three months of tests that resulted in the 
diagnosis of widely disseminated lymphoma, a malignancy of 
the lymphocytes, which are a group of white blood cells in the 
body that normally fight infection. I knew from the beginning 
that I would be treated at Memorial. I worked at the best cancer 
hospital in the world — where else would I go? 

This book is organized primarily as a collection of 
emails that I wrote immediately before, during, and after 
treatment. Most of the emails are to my dear friend Jen, 
although a few are to other people. Occasionally I include an 
email sent to me by someone else. In writing this book, I aim to 
tell a survival story accessible to all readers, to help people 
living with cancer or other serious illness (either personally or 
in a loved one), and to help doctors take better care of their 
patients, from my unique perspective as both a cancer doctor 
and a cancer survivor. 

My friends who were kind enough to read and comment 
on the manuscript have asked me if it is memoir or fiction. The 
book is memoir. As President Barack Obama writes in the 
introduction to Dreams from My Father, the book is almost 
entirely true as written, but I have taken liberties, such as 
altering the order, time frame, or dates of events, compressing 
two characters into one, and changing some of the characters' 
names or backgrounds, primarily to protect the privacy of 

I gratefully acknowledge the help of my friends, 
including Ellen, who suggested that I write about my cancer 



experience; Maureen, who used her cancer battle to guide me 
through mine; my sister-in-law, Laura, whose resilience and 
humor gave me hope; Monique ("Q") 5 who helped me believe 
that I would survive; and Christine, who makes the world's 
most fabulous hats. I'm indebted to Richard I. Dewitt for 
magnificent photography, Todd Engel for beautiful cover 
design, Angela Hoy for shepherding me through the publication 
process, and Steve Bennett, Nancy MacDonald and colleagues 
at AuthorBytes for their spectacular work on the website, 

I thank my father for his love and inspiration; his spirit 
is always with me. I thank my mother for her caring, support, 
and priceless artistic advice. I gratefully acknowledge my 
brother for teaching me the alphabet when I was three and for 
always being able to make me laugh. Thanks to all who wrote 
to me and prayed for me during my treatment, and to the 
amazing doctors and nurses at Memorial Sloan-Kettering 
Cancer Center, who saved my life. 

Laura Liberman, M.D. 


Chapter 1 
Getting Ready 

Reach out to your friends. Write about it. 

From: Laura 

Sent: Friday, March 2, 2007 10:55 PM 

To: Jennifer 

Subject: News 

Hi Jen. I had hoped to talk to you on the phone today, 
but I'm in a whirlwind. I've just been diagnosed with an 
aggressive lymphoma, involving lymph nodes, bone marrow, 
spinal cord, and the fluid around my brain. I have to have a tube 
put into my chest on Monday, David and I tell the kids next 
weekend, I get another tube put in my brain the following 
Monday, and I start chemo on Thurs 3/15. 

Apparently I've got a 50/50 shot of going into remission 
if I do this. I can make a 50/50 shot, don't you think? 

I'll be playing stuff by ear — probably not taking care of 
patients for awhile, but will continue my research and 
administrative work. 

I know that neither of us was religious when you lived 
in New York City, but we haven't talked about it for awhile. If 
you pray, please put in a word for me; if you don't, would you 
mind starting now? 



From: Laura 

Sent: Monday, March 5, 2007 9:37 PM 

To: Jennifer 

Subject: Today 

Hi Jen. Today I had a tube called a Mediport catheter 
put in my chest in Interventional Radiology. Phil, my 
oncologist, said it wasn't essential — that if I didn't want the 
catheter, they could just put in an intravenous (IV) every time I 
need to get IV chemo — but I've seen too many patients who get 
stuck for every chemo, and they dread it. Also, it sounds like I'll 
need six months of chemo, a lot of which will be intravenous. 
There's no way my veins would hold out through all that. I 
figured getting the catheter would spare my veins from repeated 
needle sticks. And they said they can take it out after I've 
finished all of the chemo treatments. 

The Mediport was no big deal. They give you IV 
sedation and then do the procedure under local anesthesia, using 
fluoroscopy, which looks like a TV screen that shows you x- 
rays of what's going on in your body, so they can see what 
they're doing. After making a tiny incision, they insert this 
sterile plastic catheter into the superior vena cava, a big vein in 
the chest that leads directly to the heart, and then close the skin 
over it. They put some sticky stuff called Dermabond on the 
skin over where the incision was made to help it heal, and then 
place a bandage over that. Once you have the catheter, they can 
deliver all the IV chemo through that. 

It feels so odd to be a patient at the cancer hospital 
where I've been a doctor for 17 years. I must have thought that 
being a doctor, wearing that white coat, confers immunity — like 
cancer is something that happens to other people, and couldn't 


possibly happen to me — but apparently that's not the case. 
When they brought me the consent form for the Mediport, I 
signed the wrong part — I signed as the doctor, because that's 
where I always sign! They said no, you have to sign as the 
patient now. Sometimes I feel like I'm in a play where I know 
all the lines, but they have me reading the wrong part. 

Write to me — little things about you, Sophie, Jim, 
music, work, life in Philadelphia, and how your pregnancy is 


From: Laura 

Sent: Tuesday, March 6, 2007 8:10 PM 

To: Jennifer 

Subject: Chemo 

Hi Jen. It's great that you're still finding time to play the 
cello. I haven't been playing the piano much these days, 
although I'm a dedicated listener. I miss playing music with 
you. For me, the best thing about taking that chamber music 
class at Mannes Conservatory ten years ago was that we got to 
meet! It was a real departure for me, because in all of my piano 
training as a kid, my teacher insisted that being a soloist was all 
that mattered; playing with another person was considered 
"accompanying" and a lesser art. I'm glad she was wrong. 

When we met in that music class, I thought it was so 
cool that you played the cello, especially since traditionally the 
cello used to be considered "unladylike." I thought, "Here's a 
woman unabashed by gender stereotypes." You go, girl. 


Let me fill you in on how this all began and what 
treatment I'm going to get. Around Thanksgiving, I started to 
have neurological symptoms including loss of fine control in 
my left arm and left hand. It was subtle — I noticed it most when 
I was doing breast needle biopsies, because hitting a tiny target 
requires precise control of both hands, and my left hand just 
wasn't doing what it was supposed to do. I saw a neurologist at 
my hospital named Sam, an expert in the field. Sam thought my 
neuro exam was OK, but he decided to do more tests. 

I won't bore you with the details, but the bottom line is 
that I had magnetic resonance imaging (MRI) exams that 
showed a mass in the cervical spinal cord, the area in the neck 
where Christopher Reeve's paralyzing injury was. I had a spinal 
tap, which they call a lumbar puncture or LP, a procedure in 
which they stick a needle into your back and take out some fluid 
from around your spine and brain. I then had surgery to remove 
an enlarged lymph node. Subsequently, I had a bone marrow 
biopsy, which must be the most painful procedure on earth. The 
tests showed lymphoma, a malignancy of lymphocytes, a type 
of white blood cell that fights infection. Thank God for Sam — 
he was like a dog with a bone, and he wouldn't let go until he 
got the diagnosis. Then he referred me to Phil, one of the best 
lymphoma docs here, to talk about treatment. 

My husband came with me to see Phil for that 
appointment. Phil said it's good that I'm relatively young (47) 
and pretty healthy, but not good that the lymphoma is in 
multiple sites (Stage IV), including the central nervous system. 
He discussed it with the other lymphoma docs, and they want to 
give me three different kinds of chemo, each one about six 
times, so probably 1 8 treatments in all, over the next six 
months. He says that even one of these kinds of chemo is tough 
to tolerate; three will be a real challenge. 


For the lymph nodes and bone marrow, I need IV chemo 
called R-CHOP. The R is Rituximab, a monoclonal antibody 
directed against the specific malignant cells in my lymphoma; C 
is cyclophosphamide (also called Cytoxan); H is doxorubicin 
(formerly Adriamycin; don't ask me why they use "H" for that); 
O is vincristine (originally called Oncovin, hence the O); and P 
is prednisone, an oral steroid. The R-CHOP will be given at 
least once a month for six months; I go to the outpatient chemo 
suite, get my Mediport hooked up to an IV, and stay for seven 
or eight hours; then I go home on five days of oral prednisone. 

The second kind of chemo is called high-dose IV 
methotrexate, which I'll also probably need once a month for 
six months. They need very high doses of methotrexate to get 
into the spinal cord, and with it they have to give tons of IV 
fluids because otherwise the methotrexate can crystallize in the 
kidneys and cause kidney damage. So every time I get it, I have 
to get admitted to the hospital, have the IV hooked up to my 
Mediport, get a ton of fluid and the methotrexate, and follow it 
up with what's called "leukovorin rescue," which helps fight the 
toxicity of the methotrexate, and I get more fluid to flush the 
excess methotrexate out of my system. Each admission will be 
from three to five days. 

I also need to get outpatient methotrexate given 
"intrathecally," which means directly injected into a tube or 
catheter called an "Omaya" that they are going to 
neurosurgically implant into my brain. I'll probably need six of 
those too, but I'm not sure exactly when and how often. 
Tomorrow, I have an appointment with the neurosurgeon who 
will put in the Omaya next week, so I'll find out more. 

David and I are trying to take all this in as the 
lymphoma doc is talking. I'm thinking if I'm going to die 
anyway, maybe I'd rather spend the next few months at home 
instead of getting brain surgery and chemotherapy. I asked Phil 


what was the chance of cure. "Cure?" he asked in a tone that 
suggested that the idea of cure was ludicrous. He said he 
couldn't cure me, but there's about a 50% chance that he could 
bring the lymphoma into remission, which means at least 
temporarily under control. That means that there's a 50% 
chance that he won't get me into remission and I'll die. Then 
David and I went to see Sam. I asked Sam if he thought I should 
get treated, and he said yes. 

After we finished with the doctors, David and I went to 
get a cup of coffee and talk. We were both shell-shocked. "If 
this is a nightmare, can I wake up now?" I asked him. He 
paused, head down, before responding, "I wish we could." He 
looked as scared as I felt, and he doesn't scare easily. I brought 
up the possibility of declining treatment. My symptoms are 
mild, I said; maybe the lymphoma will never progress; the 
treatment may be more dangerous than the disease. I don't want 
a pyrrhic victory, winning the battle but losing the war — if 
killing the cancer kills the patient, it doesn't do much good for 
anybody. But both Phil and Sam think I should be treated, I 
have a husband and two kids, and I have a 50% chance of 
surviving. I have to take that chance. I told David I'd take care 
of the lymphoma if he'd handle the paperwork. Together we'd 
decide what and how to tell the kids. He nodded. 

Jen, I'm scared. I understand all of this stuff 
intellectually but it's different when you're the one going 
through it. You can get heart damage from the doxorubicin, 
permanent neurological changes from the vincristine, manic 
from the prednisone, and painful ulcers in the lining of your gut 
anywhere from top to bottom from the IV methotrexate. You 
can become a vegetable from the brain surgery or from the 
lymphoma in the central nervous system, and God knows what 
injecting chemo directly into the fluid around your brain can do. 
And chemo suppresses your immune system, leaving you 


vulnerable to infections which can kill you. So you can die from 
the chemo or from the lymphoma itself. 

It's weird. As a doctor, I've always advised patients not 
to think too far down the line, worrying about stuff that's five 
steps away, because in medicine, each outcome affects what 
decisions you'll have to make in the next step. It's best just to 
deal with the immediate decision, see what happens, and take it 
from there. Apparently that's easier said than done. Physician, 
heal thyself. 

Please keep writing and praying, and I'll do the same. 


From: Laura 

Sent: Wednesday, March 7, 2007 9:12 AM 

To: Ellen 

Subject: Your talk 

Hi Ellen. Hope you had a safe trip home! 

The talk you gave to our women faculty about your 
book, Every Other Thursday, was incredibly well received. 
People were inspired by your experience of creating a group for 
mutual support and guidance consisting of women scientists and 
administrators that has met every other Thursday for 30 years. 
I'll send you separately our survey results from your talk; these 
are among the best scores any event has received in the 1 5 
months the Program for Women Faculty Affairs has existed! 

Unfortunately, "Every Other Thursday" now has new 
meaning for me. I just found out that I have lymphoma, and I 
gather that my chance of surviving this is 50/50. Next week I 


begin six months of chemo, which will probably be every two 
weeks, and usually it will start Thursday: every other Thursday. 

My husband has been amazing, and I've also found a 
small group of close women friends, one of whom has had 
cancer, who I know will help me get through this. Did your 
group ever get into health issues? Do you have any suggestions 
about group work for this? 

Best wishes 

From: Ellen 

Sent: Wednesday, March 7, 2007 10:03 PM 

To: Laura 

Subject: Re: Your talk 

Dear Laura, 

Thank you for the wonderful personal comments and 
feed-back. I have been telling everyone that the MSKCC talk 
(and visit) was one of the most interactive and interesting, and 
just plain FUN that I've had. I'm delighted people responded so 
positively. Now to move to your personal news. 

I am speechless. I received your message this morning 
from my step-daughter's home, where we often spend Sundays 
and Mondays; we went directly there from the Oakland airport 
Sunday when I returned from my east coast visit. I was online 
because I was checking flights to Florida for a sudden trip: my 
husband's brother passed away yesterday. It was hard, 
especially in that context, to process your bad news, but now 
home, I've reread it several times and settle down to reply. I 


realize you must have known most of this when we met last 
week, and understand your choice not to share it and have it 
"color" our whole interaction, though I would have been glad to 
talk of it then too. I appreciate your telling me now, and I hope I 
can be, albeit at a distance, one of the women friends who help 
you through this. I did feel a strong rapport, over books to be 
sure, but also attitude! You are perfect for the job you are 
putting so much into along side your medical profession. 

50/50 must be incredibly hard to hear. It is nearly 
impossible to process statistics of that nature, even (or maybe 
especially) when your professional life is involved with 
detection and diagnosis. 

Yes, we talk about health issues in Group. Scares that 
turn out OK (lumps that are benign), and Christine's that was 
major breast cancer. One of the things I quote in the book from 
her is "There is a new personal reality that comes from having 
cancer. When someone says you have a 30 percent instead of 20 
percent chance of metastasis, what does that mean in life terms? 
Do you do something differently?" I remember how we 
celebrated when she was told chemo wouldn't be necessary, 
then the doctors reversed that decision based on a cellular 
observation that none of us really understood in medical terms. I 
think the MOST important lesson is the value of reaching out, 
leaning on others whenever you can, and knowing that no 
matter how supportive and wonderful your family (I'm glad 
your husband is amazing; he'll need to be, and you deserve it), 
you need others as well, because your family will be scared 
along with you. 

I feel you know so much more than I do about cancer 
and medicine, and I'm no guru, even if you do like my book so 
much. But I will say that the ability to ask is critical. Let 
yourself talk through the fears, ask for everything you need, and 
depend on your friends to say when they can't deliver and you 


need to ask someone else. Also, one anecdote (I know everyone 
has them, but this one is very close to me). My closest friend 
from college had breast cancer which spread to her brain (10 
years after the first diagnosis, lump removal chemo, and 
radiation, one year after a recurrence and mastectomy). She was 
given "2-3 years to live" after aggressive radiation. One of the 
things she chose to do with her time was to visit Peru (Machu 
Pichu in particular), which she did with a sister, a niece, and 
me. It was an incredible trip for all of us. But the important 
thing is that now, six years later, she is still alive, is working 
(she's a teacher) again, has moved to Oregon where her husband 
had always wanted to live, and is, well, living. Scans are now 
every six months instead of every three. Her chances for 
remission were considered much less than 50/50. 

There is a certain fear in writing to someone dealing 
with such big issues, that one will say something "wrong." 
Telling you Ruth's story is one of those, and I went back and 
rewrote it. But I believe that you can sort out the helpful from 
the useless and will forgive statements that are clumsy or ill- 
considered. I'll certainly keep in touch, and I ask you to keep me 
posted as you can. One thing my friend Ruth (above) did was to 
have a kind of e-mail "cancer journal" that she sent to about 30 
friends and relatives that she wanted to keep informed. 
Sometimes frequent, sometimes with gaps of several months, 
but a way to share her experience without writing individual 
letters when her strength was limited. 

I am missing yet another Group because of this funeral, 
but I will some time ask them for advice about group work, 
especially Christine. And with your permission, I'll tell Ruth 
about you. She's been involved for years (since way before the 
cancer) with something called co-counseling and I know that 
she derived much support from discussions in that structure. But 
maybe right now is the time for just getting started, and for 



collecting resources and surrounding yourself with people who 
can help. 

With great affection and all the hope and strength I can offer, 

From: Laura 

Sent: Thursday, March 8, 2007 5:40 AM 

To: Ellen 

Subject: Writing 

Hi Ellen. Thanks for your speedy response! I love your 
idea of the "cancer journal." I've been thinking about writing a 
book about being a cancer patient and a cancer doctor — I think 
it would help me deal with the experience and might be useful 
to other cancer patients, their families and friends, and doctors. 
And yes, please tell Ruth about me. I would love to hear from 
her and others in your Group. 

While you were here, you asked about the other work I 
do at Memorial, but then we didn't have time to get into it. I 
came to Memorial as a radiologist specializing in Breast 
Imaging in 1990, right after I finished training. For the next 15 
years, I read mammograms, breast ultrasound exams, and MRI 
of the breast, and performed breast needle biopsies, where we 
take a sample of a breast abnormality with a needle to send to 
pathologists who see whether it's cancer. I teach medical 
students, residents, fellows, and other doctors. I also do breast 
cancer research focusing on breast needle biopsies. I've written 
about 100 scientific papers and co-authored a book — like you, I 
love to write! 



A few years ago, I was a member of a Women's Task 
Force created by our Physician-in-Chief to discuss issues 
related to women faculty at Memorial. We had monthly 
discussions and gave a survey to women faculty to find out their 
concerns. We found that women were significantly more likely 
than men to say that they were unclear about promotion criteria, 
that they lacked a mentor or had a mentor who hindered their 
career, and that they struggled with issues of work/life balance. 
We suggested creating an ongoing office to address women 
faculty issues. The Program for Women Faculty Affairs 
(PWFA) was created in October 2005, and I was chosen to be 
the Director. 

For the past two years, I've spent two days a week in the 
Women's Office and three days a week in Breast Imaging. I 
love my work in the Women's Office. Since the program was 
new, I got to help create it. I made a database of all faculty that 
included their departments, ranks, and tracks so I could get 
baseline data on positions of female vs. male faculty, created a 
website to share information relevant to women faculty, 
organized seminars on promotion criteria and other topics of 
interest to women faculty, began helping women individually 
with career decisions and promotion packages, and created 
Athena, an informal networking group for women faculty that 
meets monthly. 

With this illness, I'm especially glad about my mid- 
career shift. I had reached a point in my life when I want to be 
more of a mentor and help other women succeed, rather than 
pursuing the spotlight for myself — kind of like I'd rather play 
chamber music than be the soloist. The Women's Office work is 
rewarding but not as physically and emotionally grueling as 
clinical care of cancer patients. I also have more control over 
my schedule in the Women's Office than in clinical work. The 



flexibility will be essential when I'm going through cancer 

Got to go. I don't sleep too well these days. I get up in 
the middle of the night and read or listen to music for awhile, 
but then I seem to hit a point when I run out of steam and have 
to lie down. I just hit that point. 

I'll keep you posted. I so appreciate your offer to be one 
of my women friends who gets me through this! 


From: Laura 

Sent: Thursday, March 8, 2007 10:07 AM 

To: David 

Subject: Yes we will 

Hi Babe. I love you. We will get through this, and then, 
what a book I'll have to write! 



Chapter 2 
Telling the Kids 

Be sensitive to your family. 

From: Laura 

Sent: Saturday, March 10, 2007 6:43 AM 

To: Jennifer 

Subject: Saturday 

Dearest Jen, 

Thank you so much for your daily notes; I can't tell you 
how much I enjoy reading them. I'm so glad you kept the 
maternity clothes from your last pregnancy. I bet you look great 
in your new Pashmina. I've never seen a Pashmina in real life — 
only on one episode of Friends, when Jennifer Aniston goes out 
on a shopping spree. 

I've been in a flurry of activity since I last wrote. 
Wednesday I saw the neurosurgeon, Mark, to plan the Omaya. 
He explained how he was going to neurosurgically insert the 
Omaya catheter into my brain, so they can deliver chemo 
directly into the cerebrospinal fluid (CSF), which is the fluid 
around the brain, around the spinal cord, and in several little 
water-balloon-like structures in the brain called "ventricles." 
Mark is a fabulous surgeon and a likeable guy, quiet with a 
warm sense of humor, although I told him I preferred our 
relationship when it was limited to my reading films about the 
hardware he's putting in other people! He says they used to do 
about 50 Omayas a year at Memorial, but now they do about 20. 
He's done a lot of them, and knows what he's doing. 



There were two moments in the visit that I didn't like. 
The first was when he told me how they have to drill a hole in 
the skull and put the Omaya through the hole and through brain 
tissue until the tip reaches one of the ventricles. In describing 
the procedure, he showed me a picture of a brain with a catheter 
in it. I had never quite realized how far the ventricles are from 
the surface of the brain! 

The second part of the visit that I didn't like was when 
he told me the Omaya will be there forever. I hadn't realized 
that. It makes me feel like my life is divided into my world 
before this Monday (pre-Omaya) and my world after this 
Monday (post-Omaya). They also have to do this under general 
anesthesia. So the brain surgery part is intimidating. You know 
how in your whole life, when people ask you to do something 
hard, you always think to yourself, "Well, at least it's not brain 
surgery!" Well, now it IS brain surgery, so what am I supposed 
to say — maybe, "It isn't rocket science"? 

When the neurosurgeon left the room I asked his nurse 
who's been at Memorial for 36 years if it was OK to cry for a 
minute and she said it was. She told me that when she used to 
be a floor nurse, she would tell the patients they were allowed to 
cry for 20 minutes a day. Apparently there are no restrictions on 
the time of day you can cry, and you're able to do it all at once 
or break it into smaller sessions, eg 2 crying sessions of 1 
minutes each, or 4 crying sessions of 5 minutes each, or even 1 
crying sessions of 2 minutes each. I took her card and her 
number. That advice may come in handy. 

Wednesday night I dragged David to a seminar run by 
Social Work on how to tell your kids that you have cancer. I 
wish you had been there to give me the child psychologist's 
perspective on the seminar. We met in a small conference room 
in the hospital. There are three big windows that look out on the 
Rockefeller campus across the street, but the curtains were 



drawn. Usually the room is arranged formally, with all the 
chairs lined up in rows facing the podium in front. For this 
seminar, it was more casual, with the chairs in a little circle. 

David was on my left, and my friend Maureen was on 
my right. Maureen is a doctor here — last year, when her 
daughter Julie was 10, Maureen was diagnosed with 
endometrial cancer, and had surgery, radiation, and 
chemotherapy. She lost her hair with the chemo, and it's 
coming back even a more flaming red than it was before. 
Maureen is heroic and blunt — the cancer was no match for her. 
She's seen it all, tells it like it is, and is fearless — a terrific ally 
to have in your corner. 

The seminar began by us going around the circle and all 
the participants introducing themselves and telling why they 
were there. The people at the seminar were a bizarre mix. The 
first woman on David's left was an inpatient wearing her 
hospital gown and pushing her IV pole, and she seemed 
disturbed. She has cancer widely spread throughout her body, 
but they aren't sure where it began. Her kids are grown up but 
she has a 5 -year-old granddaughter in her care. She would not 
stop talking. The social worker finally had to interrupt after she 
had spent ten minutes on an intensive discussion of every 
symptom and test she had that led up to her diagnosis of cancer. 

On her left was a couple, a man and his extremely 
pregnant wife, and she was crying hysterically from the moment 
they walked into the room. I thought she must have something 
terrible. Turns out her father has cancer, and what they're 
worried about is, how do they tell their 2-year-old daughter 
that Grampa is sick? I'm sorry, let's not compete over whose 
problem is worse, but telling the two-year-old that Grampa is 
sick just isn't on the same page as telling your teenage kids that 
you have cancer. Afterwards, Maureen told me, "I know how 



they should tell their two-year-old. Say 'Grampa's sick,' and 
then turn on Blue's Clues, and she'll be fine." 

The third couple in the group was a husband and wife in 
their late 30s or early 40s. The mom, who is fine, lost her 
mother to cancer at a young age, and hadn't been given 
complete information. The dad has had adrenocortical 
carcinoma for three years, very aggressive and not treatable by 
chemo. He has had multiple recurrences, all treated surgically, 
so he has had to disappear from home for months at a time. 
Apparently they never told their son, Billy, that Dad has cancer; 
when Dad needs surgery, he just disappears in the hospital for a 
month or two, and they tell the son that it's orthopedic surgery 
due to a skiing accident Dad had years ago. 

Now Billy is 7, and the mother really wants to tell the 
kid, but the father refuses. In the session, the father kept saying, 
"Nobody believes that I have cancer because I look so good!" 
It's true he looked pretty good — since he's never had chemo he 
still has his hair, etc. — but facts are facts, and he does have 
cancer. Finally the wife told her husband quietly, "I think you 
don't want to tell him because you can't admit to yourself that 
you have cancer. Maybe you figure that if you don't tell Billy, it 
isn't real. Well, it's real, and he deserves to know, just like I 
deserved to know when my mom had cancer but I wasn't given 
the chance." Her husband blinked at her, speechless. When he 
finally tells Billy, I bet the truth will hit them both pretty hard. 

The next person was a man about our age whose wife 
has terminal pancreatic cancer. I gather the wife goes in and out 
of consciousness, and he doesn't know what or how to tell their 
four-year-old daughter. She had drawn a picture for her mother, 
a crayon drawing of the family, but her mother could not 
recognize what it was. He brought in the picture to show us, 
holding it with the tenderness that he obviously feels for his 



wife and daughter. He looked lost and afraid; he clearly loved 
his daughter very much, but did not know how to help her. 

David and I went last. I said I have lymphoma and about 
to have brain surgery and start chemo, and we are trying to 
figure out how to tell our teenage kids. He just said, "I'm David, 
and I'm Laura's husband." David is a private person, especially 
with people he doesn't know. I knew that sharing the intimate 
details of his personal life with strangers at a seminar wasn't his 
style; he was there for me. 

The social worker who ran the meeting was named Tara, 
which made me think of Gone with the Wind. She was young — 
maybe in her mid thirties — with short dark hair and sparkly 
eyes. She said she had been working with cancer patients and 
families for ten years, and that we would tailor the discussion 
toward the issues confronting the people in the seminar. 

After the introductions, Tara gave us a bunch of "How 
to Tell Your Kids You Have Cancer" literature. Some of it was 
geared towards very young kids, which won't work for Nate at 
age 17 and Emma at age 14. For example, they had an 
interactive workbook with a colorful cover and outlines of a 
female body, so your kids can draw where Mommy's cancer is; 
there was also a "his" version with a male body to use if they 
want to draw Daddy's cancer. We had the oldest kids in the 
room, and we were the only ones who were there before cancer 
treatment started — everyone else had been weaving elaborate 
webs of deception for months or years. 

"Be honest, but don't overload the kids with 
information," Tara explained with a faint southern drawl. "You 
want to answer their questions, and make it clear that 
throughout all this, you're still their parents, and you'll take 
care of them." She emphasized the importance of having time 
together as a family. In the cab on the way home, David and I 
talked about how lucky we are to be on the same page about 



how and what to tell the kids, but we've been on the same page 
for most of the 3 1 years we've known each other. We're 
planning to tell the kids tomorrow. I wish I didn't have to rock 
their world. But it would rock their world more if I'm not 
around, and I have to do this chemo to stick around, and I'm 
going to do whatever it takes. 

Wednesday I had pre-admission tests, including an 
echocardiogram and an EKG to make sure my heart's OK. 
Thursday I went to the dentist for a pre-chemo cleaning of my 
teeth. Unfortunately they found two cavities, so I had to have 
them filled. I'm trying to seal up all potential portals of 
infection — I feel like I'm drawing up the drawbridges of some 
ancient castle. 

Maureen had told me about the wig store on the West 
Side that she used when she had chemo, and she met me there 
Thursday afternoon. When I entered the store, a gay cross- 
dressing hair stylist named J.T., who has won Emmies for hair 
design, put me in a little room. I was wearing a green skirt, a 
sweater, and my Ugg boots. My hair is even longer than the last 
time you saw me, about five inches below my shoulders, curly 
brown with more flecks of gray than you remember, and kind of 
wild. J.T. took one look at me and said, "You're a low 
maintenance kind of gal, huh?" I laughed and asked, "Isn't it 
enough that I have cancer and need chemo and now you're 
dissing my hair?" 

I tried on a few brunette wigs, and the two I liked best 
were long — one curly and one straight. I told J.T. I wanted to 
try a blonde wig because it was my chance to see if blondes 
have more fun. He said, "Honey, I've been blonde, and trust me, 
they DON'T." J.T. has named all the wigs — the curly one was 
Chelsea, named for Chelsea Clinton, and the straight one was 
Jennifer (maybe for Jennifer Garner?) and actually looks more 
like your hair than mine. I gather I'll lose my hair about a month 



after the chemo starts. Then I go back to the wig place, they cut 
off the rest of my hair, and I go home wearing one of the wigs. 

Yesterday, I went on a "field trip" to see our new suite 
of offices with our office assistant, Lea. The building has been 
there awhile, but they just finished construction on our suite, 
and nobody has moved in yet. I had heard the building was a 
dump, with no security guard. Apparently there was a report of 
a flasher in the stairway two weeks ago, and when I told one of 
the administrators, she said, "Great, now you guys will have 
entertainment." I've since heard that the woman who saw the 
flasher "wasn't sure he was flashing." How can you be 
uncertain about that? It seems to me that if you see a guy in the 
stairway with his trousers unzipped, there are two options: 
either he's flashing or he's peeing, and neither is something you 
want a guy to do in your stairway. 

Anyway, the suite was beautiful — lots of light, big 
central space with offices all around, plenty of computers, a 
small kitchen area, two bathrooms, and a high-tech conference 
room. Best of all — the office they have planned for me has real 
windows! It is so sunny compared to our old suite, and much 
more spacious. I thought I'd never go there, but now I think I 
will. It will be a beautiful, quiet place to write. 

Today Nate takes his SATs — I hope so much for his 
sake that they go OK. Tomorrow David and I tell the kids, and 
Monday I get admitted for the neurosurgery. If all goes well, I 
come home on Tuesday night, rest Wednesday, and have my 
first chemo on Thurs 3/15. 

Got to go — Nate's up and it's time for the pre-SAT 
breakfast! Keep writing — I love your letters. 




From: Laura 

Sent: Sunday, March 11, 2007 1 1 :29 PM 

To: Jennifer 

Subject: Telling the kids 

Hi Jen. Remember the time a couple of years ago, when 
you cut back on your office hours to make your child psych 
practice part-time, four days a week, after Sophie was born? 
You told me then that you thought you had found the right 
balance, and I told you how few women ever get to say that. I 
think it's great that you're thinking of cutting back on work 
from four to three days a week after the new baby. This balance 
thing is a moving target. As soon as you get it right, something 
in life shifts, like a new baby, or aging parents, or moving to a 
new city, or an illness, and you have to go with it. I read in an 
article that people are calling it "work-life fit" instead of "work- 
life balance" these days, because we now recognize that balance 
is generally unattainable. 

We actually told the kids yesterday, rather than today as 
we had planned. Nate felt good about his SATs, and we were all 
together. I was in the bedroom with David and I told him that it 
felt like the right time to tell them, and that letting them know 
today will give them a little more time to deal with it before the 
surgery. It would also let them see me go to bed and wake up at 
home in the morning, a little bit of normal before Armageddon. 
David agreed. 

After dinner we were all sitting in the family room. You 
wouldn't recognize the kids, Jen — they've gotten so big! Nate is 
taller than I am, with sandy hair that always looks a little 
tousled, an athletic build, and those green eyes he got from 
David. Emma is petite, about 5 '2", and incredibly chic; her eyes 



are still that combination of green and blue, half David's and 
half mine (all hers). She's wearing her brown hair shorter now, 
in wisps around her face, and layers her clothes. I love how she 
wears jewelry — she'll have multiple necklaces, all different, but 
they look great together, and she prefers wearing a different 
earring in each ear ("I don't like symmetry," she explains). I sat 
on the couch, with Nate on my left and Emma on my right, 
holding both of their hands. David sat in a chair right next to us. 
I told them that I have lymphoma, a type of cancer, and that it's 
in my lymph nodes, bone marrow, spinal cord, and the fluid 
around my brain. 

I explained that I need six months of chemotherapy, 
which is strong medicine to kill the cancer cells. I said that I 
was going to get chemo at least every two weeks, and for every 
other one I have to get admitted to the hospital for a few days. I 
told them that the chemo will make me look sick because I'll 
lose my hair but that just means the chemo is working. I assured 
them that cancer is not contagious, that they can't catch it, that 
they didn't give it to me, that it's nobody's fault, these things just 
happen. I said that they could talk to anyone they liked about it, 
that it was no secret, and that I had gotten names for each of 
them of a psychiatrist they could talk to if they wanted. I told 
them that we were still their parents, that we would take care of 
them, and that David is the best dad in the world. 

I told them that some people with cancer are cured, 
some get better, some stay the same, some get sicker, and some 
die. I told them that my hospital and my doctors were the best 
on the planet, that I was going to do what the doctors told me, 
and that I would do everything in my power to be in the group 
that gets better, and that they know how stubborn I can be! I 
told them that I needed to have a tube in my chest and one in 
my head for the chemo, and that I was getting admitted to the 
hospital on Monday for one night to get the tube in my head. I 



reminded them that their Aunt Laura survived cancer, and so 
did their Grandma. And I repeated what I said to my beautiful 
sister-in-law when she was diagnosed with cancer: it sucks but 
we'll get through it. She did, and so will we. 

David didn't say much during the whole exchange, but 
he was there, quietly lending support for all of us. His response 
made me think of our wedding in his parents' house on Long 
Island. It was time for each of us to have a sip of red wine. Even 
though we had known each other for six years and lived 
together for two, I was shaking so hard that I could hardly hold 
the glass. He reached up and steadied my hands for me, so I 
could have a drink without spilling wine on my dress or 
dropping the glass. He has always been there, quietly strong. 
We're going to need that now more than ever. 

Later that night, David and I spoke to each of them 
separately. Emma wanted details, including a full explanation, 
complete with diagrams, of where the lymphoma was, where all 
the tubes were going to be, how many chemos I needed, and 
what the treatments would involve. Nate just got pale and 
serious, held my hand, and said, "I love you, Mom." 

The kids have always had their own distinct ways of 
processing information. I remember a day more than a decade 
ago when we passed a dead bird on the street while we were 
walking to school. Emma asked questions: "What is that? Is that 
a dead bird? Why did the bird die?" Nate became silent and 
asked Emma to please stop talking about it. Emma deals with 
her fears by verbalizing them and seeking clarification, while 
Nate prefers to receive information only on a "need to know" 
basis. After we spoke to the kids, Emma went into Nate's room 
and they talked in private. David and I thought that was a good 
sign that the kids will help each other through this. 

On Sunday we looked at some college application 
materials with Nate, and I took Emma out to tea. After we got 



home, Emma and Nate spent most of the rest of the day 
downloading iTunes on my computer to put on my iPod. David 
had the brilliant idea to get me an iPod and have the kids put 
songs on it so I can listen to music while I'm getting chemo. It's 
great because when they asked what they could do to help me, 
we had something to suggest that actually will be helpful. 
Emma's selections focused on Broadway musicals like Wicked 
and Spring Awakening, while Nate's had a heavy Motown 
emphasis, including Marvin Gaye and the Temptations. David 
put music on for me too — including jazz, which is still his 
passion, and some classical music that he knows I love. 

I called my mom tonight to tell her. She recently moved 
from the house where I grew up in Newton, Massachusetts to a 
beautiful retirement community outside of Boston. I didn't want 
to worry her, but there's no way I can go through this without 
telling her. She asked me what she can do to help, and I asked 
her to email me. She said she'll send me a Blue Mountain card 
every day. I love those e-cards, with their pictures and music. 

The brain surgery part is daunting. I've gotten used to 
my brain the way it is. I'm afraid I won't be me anymore. 



Chapter 3 
Treatment Begins 

Keep your sense of humor. Discover your inner Zen. 
Bring your own anesthesia. 

From: Laura 

Sent: Monday, March 12, 2007 1 1:04 PM 

To: Jennifer 

Subject: Brain surgery 

Hi Jen. I survived brain surgery! The neurosurgeon 
promised he didn't go anywhere near my sense of humor. 


From: Emma 

Sent: Tuesday, March 13, 2007 8:14 AM 

To: Mom 

Subject: For you in the hospital 

Guess what! 

I love you! 

Guess what else! 

I couldn't think of anything else. 

I love you! 




From: Laura 

Sent: Wednesday, March 14, 2007 1 1:04 PM 

To: Jennifer 

Subject: Stories 

Hi Jen. Here's a story for you. As I was getting ready to 
go to the OR for the Omaya, they told me I had to take off my 
underpants. Have you ever seen hospital-issued one-size-fits- 
none underpants? They are made of such a fine mesh that when 
you put them on a human body, they are actually clear! The 
nurse wouldn't give me the clear panties unless I was 
menstruating, so I looked the nurse in the eye and said I had my 
period, a lie I haven't told since I wanted to get out of junior 
high gym. Nothing says "vulnerable" like losing your skivvies. I 
told the nurse that if the doctor had to look in my underwear to 
find where to put the Omaya, he wasn't half the neurosurgeon I 
thought he was. The nurse looked puzzled; I don't think the 
neurosurgery patients here tell a lot of jokes. 

The surgery part was bizarre. Completely awake, I 
walked down the hall with the escort guy when it was time for 
my brain surgery. I had to remove my glasses — more 
vulnerability, especially if you're almost legally blind without 
them. David walked with us at first, but when we got to the 
door of the operating room area, he had to turn back. I went into 
the OR, which was full of shiny instruments, harsh overhead 
lights, and "the wall of knowledge" — a huge computer screen to 
provide continuous updates of the patient's pulse, temperature, 
blood pressure, oxygenation, and other parameters — and I 



realized that soon it would be my information up there. I had to 
climb onto the table and lie down. The anesthesiologist gave me 
good drugs that put me to sleep. The next thing I remember is 
waking up in my room after the surgery was done, with a bad 
headache and an even worse hair day — they'd shaved almost a 
quarter of my hair. 

Did you know that an iPod is a great cancer coping 
strategy? I have 370 songs on it, courtesy of Emma, Nate, and 
David. Waiting for and recovering from brain surgery are a 
whole lot less scary when you've got headphones in and you're 
listening to Ben E. King singing "Stand By Me." 


From: Laura 

Sent: Thursday, March 15, 2007 10:43 PM 

To: Jennifer 

Subject: Where's the Zen? 

Hi Jen — You are my most faithful correspondent! 

After my first inpatient experience, what I want to know 
is, how am I going to find the Zen to get through this treatment? 
When I was first diagnosed, David and I decided that we needed 
to look deep inside ourselves and find some inner Zen and 
patience, because being a patient involves a lot of waiting. If I 
fight everything every step of the way, it will zap all of my 
energy and I won't have any left to use to fight the lymphoma. 

And yet in the hospital, when I had to explain to a nurse 
who looked 12 years old at 3 am how to diagnose an infiltrated 
IV ("See, the left arm is now twice as big as the right, and my 



watch is making a huge dent in my arm, and you can see the 
indentation in my left ring finger, which looks like a sausage 
now, from where my wedding rings used to be before I took 
them off so you wouldn't have to cut them off in the morning"), 
or wait an additional three hours after the neurosurgeon told me 
I could go home while somebody fills out pointless paperwork, 
I couldn't hold onto the Zen even for 24 hours. But I need to 
find that Zen. I can't waste energy on stupid stuff, because I 
need to save it for what counts. A patient told me that every 
time I go to the hospital I should pretend I'm going to the 
airport, so I expect a long wait. That way, I'll be pleasantly 
surprised if I don't wait rather than disappointed if I do. I'll try 

After the IV infiltrated during my admission, they were 
going to stick me again because I needed one more dose of IV 
antibiotics, and I asked the 1 2-year-old nurse if she could please 
just use the Mediport in my chest. She said she wasn't sure, and 
would have to check with the nursing supervisor. I told her that 
the Interventional Radiology (IR) doc who put in the port said 
they could use it during this admission and so did the 
neurosurgeon, but she insisted that she could only do it if the 
nursing supervisor blessed it. I emailed the IR docs, my 
neurosurgeon, and my lymphoma doc to ask if they would bless 
using the port, and if so, could they let the nurses on 7 know? 
Miracle of miracles, the nurse came back and said they could 
use the port! 

Innocently, I had always thought that once a port is in, 
that getting injected through the port would feel the same as 
injecting IV tubing after the IV is already in place — ie, painless. 
Unfortunately, the port is under a tiny layer of skin which has 
lots of nerve endings. The term "access the port" is a 
euphemism for "I'm going to take a dagger and stab you in the 
heart." No local anesthesia of any kind — no injection, no cream, 



no freezing spray, nothing. It made me appreciate how much 
pain patients go through with the procedures we inflict on them. 
And then the nurse bragged about how she was the best in her 
nursing school class at accessing the port! For every patient to 
whom I ever said that the injection of anesthetic was more 
painful than the needle stick for the procedure, I am paying my 
penance to the universe. 

And yet, during the same admission, I experienced a 
precious act of kindness. The morning after the Omaya 
placement, a nurses' aide asked if I'd like her help washing up, 
and I gratefully said yes. I got undressed and sat on a little 
plastic chair. She gently and respectfully assisted me with the 
hand-held nozzle that controlled the wonderful flow of hot 
water while keeping my post-op head dry. It's pretty intimate 
and potentially awkward to bathe in front of a stranger, but she 
made it so simple. This woman, a non-native speaker of the 
English language without much formal education, was 
everything you could want in a caregiver. I wish I could triple 
her salary. 

Today, at home, the part of my hair that wasn't shaved 
was all tangled in knots that I didn't see how I could fix, 
especially since I can't take a real shower for a few days 
because of the neurosurgery. Carmen, our wonderful nanny 
from Jamaica who has been taking care of the kids for thirteen 
years, was there. I told you the story about how we got Carmen, 
didn't I? We found Carmen through friends who had hired her 
temporarily when their nanny was on vacation; she was their 
nanny's cousin. When we interviewed Carmen, I felt an instant 
connection. We hired her on the spot, and she's been with us 
since Emma was 18 months old and Nate was three. She's part 
of our family — great with the kids. I love to talk to her when I 
get home and have her tell me stories about what the kids did 
during the day. 



When I got home from the neurosurgery admission, 
Carmen and I were the only ones there; the kids were still at 
school. I asked Carmen to help me cut off some of the tangled 
hair before the kids got home. We went into the bedroom and 
she cut a few snips. Clumps of hair fell like parts of a bird's nest 
on the bed. Afterwards, I saw that even a "combover" doesn't 
cover the shaved part of my head, which looks like 
Frankenstein: at the site of the Omaya, I have staples, bruising, 
and a big bump. It's a little scary even for me; the kids would 
not like it. As Carmen was finishing up, we heard the front door 
slam; Nate was home. I quickly searched my closet, put on a 
Yankee's cap, and went to kiss him hello while Carmen threw 
away the evidence. I suppose eventually the kids will have to 
see my head, but not now, not yet. 

Today, I was scheduled to get my first intrathecal chemo 
injected into the Omaya and then my first IV R-CHOP. After 
experiencing the pain from having the Mediport accessed, I 
decided I would bring my own anesthesia. I brought a bottle of 
Gebauer's Ethyl Chloride spray, a freezing spray that numbs 
instantly. As a doctor, I had been using Ethyl Chloride spray for 
years to numb the breast during pre-operative needle 
localizations, a procedure in which we put a wire in the breast to 
guide a surgeon to a breast abnormality that can't be felt. I also 
brought a tube of Emla cream, another medication that numbs 
the skin but takes half an hour to work. 

When I went to the lymphoma service and they 
described how they were going to stick the Omaya, I asked if 
they used anesthesia. To give an intrathecal injection, they need 
to put a needle into the Omaya; since the part they inject is sewn 
under your scalp, you can feel it. They told me that this area 
"cannot be numbed." I pulled out the bottle of Ethyl Chloride 
spray and said, "Actually, it can!" I explained that we use this 
spray in Mammo for needle Iocs and that it really helps ease the 



pain. I asked if they could please use it for me, and they did. 
After the spray, my oncologist and another very experienced 
doc dug around my head with a needle for about 10-15 minutes 
and couldn't find the Omaya, so they gave up. If I hadn't had 
the spray, it would have been torture. 

I have to go back Tuesday for them to try again; I've 
invited the neurosurgeon to join us, so he can show them where 
to go (I'd like to tell them where to go!), and he has agreed to 
come. I think part of the problem is that the neurosurgeons put 
the Omayas in but the oncologists inject them. Since 
neurosurgery only puts in about 20 Omayas a year, and there 
are far more than 20 oncologists, most oncologists don't have 
much experience with intrathecal injections. When the 
oncologist recommended that I bring the spray on Tuesday 
(which I will do — I'm bringing it everywhere from now on), I 
suggested that maybe it would be good to get some spray for the 
clinic, so that all patients would benefit! Patients rarely come 
armed with their own anesthetic spray. I hope you never get 
cancer, but if you ever do, don't leave home without the spray. 

I had a blood test and then went to the outpatient chemo 
floor to get my first R-CHOP. Waiting for chemo felt like being 
in line for a table at a crowded restaurant — they asked for my 
cell number, so they could call me when the chemo was ready. 
They wait for the blood test results before they "mix the 
chemo," which then takes an additional two hours after the 
blood test result is ready. They want to make sure that your 
blood counts are normal before they give you chemo. While I 
was waiting, I got to have breakfast with David. Finally, they 
called around 12:30, and we got started. 

I went up to the 4th floor, Suite 7. It's outpatient chemo, 
but it looks like an inpatient floor. The room was private, with a 
bed, two chairs, a TV, and a private bathroom. I had brought a 
fuzzy turquoise blanket from home. My nurse was named Lois, 



and she was very nice. She used the spray on my port before she 
"accessed it" and she laughed at my jokes even though I doubt 
that they were funny. They run in the first chemo slowly, over 
6-8 hours, so they can monitor for an allergic reaction. They 
started with the Benadryl (anti-histamine), Dexamethasone (an 
injectable steroid), and a slew of anti-nausea pre-meds in 
preparation for the Rituximab (monoclonal antibody), followed 
by the Cytoxan with a lot of fluid, the doxorubicin (which is 
bright red and will make me pee pink!), and the vincristine. 

The problem with most chemo is that it works by killing 
rapidly dividing cells. Cancer cells divide rapidly, so chemo can 
kill cancer, but unfortunately some normal cells also divide 
rapidly, like the cells that make hair, causing hair loss; and the 
cells that become blood cells, including red blood cells, so you 
get anemic; platelets, so you have a tendency to bleed; and 
white blood cells, so you're prone to infection. Giving chemo is 
the ultimate game of chicken — you explode a big bomb in the 
patient and wait to see who dies first, the cancer or the patient. 

The complications of chemo that can kill you are mostly 
related to the innocent bystanders like white blood cells who get 
hit in the cross-fire. Now there are medicines that are "growth 
factors" that help some "good cells," like blood cells, recover 
faster, so a cancer patient is vulnerable for a shorter period of 
time; this has greatly helped survival. Hopefully in the future 
we'll have more "targeted therapies" — medicines that will 
specifically attack the cancer cells, while leaving the innocent 
bystanders alone. Unfortunately, now we usually still explode 
the bomb. 

David stayed with me the whole day. He was in a chair, 
reading. He loves to read Big Fat Books — I call them BFBs — it 
started with that multi-volume biography of Lyndon Johnson by 
Robert Caro a few years back and has continued since then — I 
worry that he will fall asleep with one of those humungous 



tomes and will suffer a BFB injury! Some friends from the 
hospital came to see me, including Cindy, our Chief 
Technologist in Breast Imaging, whom I've known since we 
both started working at Memorial 17 years ago. 

Nate visited me after school. He was on his way to 
Pediatrics in my hospital to interview for a volunteer position 
dealing with children who have cancer. Working in Peds was 
Nate's idea — he loves to work with children. I think it's a great 
idea for that reason and also because it might help him cope 
with my illness. He likes to deal with a difficult experience by 
turning it into a way he can help other people. I hope it won't be 
too tough on him emotionally; some of those kids with cancer 
are really sick. 

I did fine with the chemo — no reactions or anything — 
and was done earlier than expected, 6:30 instead of 8:30 pm. So 
now we're home, and I can rest. If I feel up to it I may go to the 
office tomorrow. Apparently I won't get to "nadir," which is the 
lowest point in the white blood cell count, for about a week; 
that's when I'll be particularly susceptible to infection. They 
say that the effect of chemo is cumulative; it's likely that I'll 
feel more exhausted after more chemos. The doctors think I'll 
need a total of 1 8 treatments (six outpatient IV R-CHOPS for 
the nodes and marrow, six outpatient intrathecal methotrexates 
for the fluid around my brain, and six inpatient IV 
methotrexates for the spinal cord disease), so now I just have 17 

Keep writing. It makes sense that you're not accepting 
new patients for now — that will make it easier for you to make 
the switch from four to three days a week when the time comes. 
And I agree that having it all may not be what it's cracked up to 
be. As the great comedian Steven Wright says, "You can't have 
everything — where would you put it?" 




From: Laura 

Sent: Friday, March 16, 2007 8:56 AM 

To: Jennifer 

Subject: Home 

Today I'm home resting. Emma has a snow day so she's 
home too. We're listening to the CD of a Broadway musical 
we're seeing next month called Spring Awakening. We're going 
to make some tea and have a cozy day together. 


From: Laura 

Sent: Saturday, March 17, 2007 4:14 AM 

To: Jennifer 

Subject: Awake 

Hi Jen. I have a feeling there may be quite a few 3-5 am 
updates, especially when I'm on prednisone, the oral steroid I 
have to take for about five days after every R-CHOP (I hear 
prednisone is a good medicine to take when you need to clean 
your apartment). The prednisone seems to wake me up from 
3:00 to 5:00 am even though I'm on enough sleep meds to kill a 
pretty large race horse. I guess it will help me get a jump start 
on my book. 



I'm going to listen to music and try to get back to sleep. 
I'm in the mood to hear Jacqueline du Pre play her rich and 
passionate performance of Elgar's cello concerto. I remember 
the stories you told me about Jacqueline du Pre: how she used 
to play duets with her husband, Daniel Barenboim, who was a 
pianist and conductor; how she developed multiple sclerosis, 
making her unable to play the cello; and how the rest of her life 
after that was very rough. Knowing about her illness, I found it 
sad to read the back cover of the CD, which reports an interview 
her husband gave before she got sick, when he said that the best 
thing about their relationship was that "our life and work are 


From: Laura 

Sent: Saturday, March 17, 2007 1 1:20 AM 

To: Radiology staff 

Subject: Thank you 

Dear Radiology colleagues: 

Thank you for the beautiful gift basket, and the note that 
accompanied it. As many of you know, I have an aggressive 
lymphoma and need six months of intensive chemo. If all goes 
well, I'll be done with the chemo by September. 

After four years as an intern/resident at MSKCC and 17 
years on faculty here, I finally get to see what it's like to be a 
cancer patient. You know that song, "I'd rather be a hammer 
than a nail"? Well, yes I would! Anyway, I'm writing a book 
about it. You know I love to write. 



I appreciate your kind wishes and (if you're up for it) 
your prayers. My wonderful family and friends are helping me 
get through this. Thank you. 


From: Laura 

Sent: Sunday, March 18, 2007 9:07 AM 

To: Jennifer 

Subject: Shower 

Hi Jen. Guess what? Yesterday I got to take my first real 
shower since I had neurosurgery! My being unable to shower 
for five days was a true test of my husband's love, and I'm 
delighted that he passed. 

The neurosurgeon told me to use Baby Shampoo, so 
David went out to get it for me. He came back with a bottle of 
Johnson's baby shampoo with a Spanish label that said 
something about "mata" on the front. In Spanish, matar means 
to kill, so I told my husband, I send you out and you come back 
with death shampoo? I told the kids if they heard any 
explosions from the bathroom they should come in with a hose. 
So my poor darling husband went out again (I was really just 
kidding) and came back with two bottles of Johnson's Baby 
Shampoo, both labeled in English (one had a Detangling 
Formula). Neither mentioned death in any language anywhere 
on the label. I was surprised they had Baby Detangling 
Shampoo; I never thought babies got tangles — maybe they 
don't, which is why there were so many bottles left in the store! 



What a shower it was. Feeling the warm water cascading 
over my head, I closed my eyes and recalled the first time I 
went snorkeling in the balmy turquoise waters of the Caribbean. 

Tonight we're going out for a surprise party for my 
husband's 50th birthday. The last time I tried to give him a 
surprise birthday party was when we were in college. I had 
bought him a cake and lit the candles in the dorm room of his 
friend, an Egyptian named Sammy. Trying to convince David to 
come to his room, Sammy said, "David, I have to talk to you in 
my room!" and David asked, "Why not tell me here?" and 
refused to come until Sammy spilled the beans! The candles 
were all burned down into wax on the cake by the time they 
showed up. I had sworn never again. But that was about 30 
years ago, and I figured that the statute of limitations should 
have expired by now. 



Chapter 4 

It 's not all about the cancer. 

From: Laura 

Sent: Monday, March 19, 2007 4:36 AM 

To: Jennifer 

Subject: David's birthday party 

Hi Jen. Since you're my "gentle reader," let me tell you 
about David's 50th birthday party last night. (Note the ungodly 
time on the email; I'm still on the five days of prednisone from 
the R-CHOP, and it continues to get me up from 3-5 am daily. 
Maybe I should call my book "The Prednisone Diaries.") 

I'd been thinking about throwing a surprise 50th birthday 
party for David for a long time. A few years ago, we went to a 
party for our closest friends, the Berkowitzes. Our dear friend 
Steve Berkowitz turned 50, and his wife Monique (we call her 
"Q"), threw him a fabulous dinner party that occupied a small 
floor of a little bistro downtown. Q had invited friends from all 
times in Steve's life: growing up in Boston, playing in a band, 
and rising through the record industry in NY. Each of them got 
up and told moving and funny stories about Steve from his 
childhood through his adult life. The party inspired me to do 
something for David's 50 birthday. 

I enlisted Q to help me plan the party. Given everything 
that was going on, we decided to keep it simple, with just the 
four of us (me, David, Nate, and Emma) and the four of them 
(Q, Steve, and their sons, Nick and Ben). Our families have 
been close for years. Our nanny had befriended their nanny in 



Carl Schurz Park when Nick and Nate were babies, and the 
boys bonded right away. I first met Nick when I was pushing 
Nate, then 1 8 months old, in his stroller in the park. Nick waved 
and said, "Hi, Nate!" It was the first time, to my knowledge, 
that somebody with whom I was unacquainted knew Nate. In 
that moment, Nick taught me that Nate was someday going to 
have a full and independent life that did not always include me! 
Shortly after that, we all met in the park. Q and I became 
pregnant with our second children at around the same time and 
became close friends. The eight of us have spent every New 
Year's Day together for about 1 5 years, at our place or theirs. 

David still loves jazz, and loves to take the kids to jazz 
clubs. One of his favorite clubs in the city is a funky place 
called the Jazz Standard, which has great live music and serves 
dinner. Q and I looked at the schedule of who is playing, and it 
turns out that this weekend they had a quartet with a pianist 
named Bill Charlap, who I knew David liked. We decided to do 
it on Sunday night. 

The kids liked the plan, especially the part about 
keeping it a surprise from David. Nate tried to help me make the 
reservations, but when he told them it was for a party of eight, 
they said you can't make reservations for 8 people. So I called 
back the manager and said, "Listen, I have cancer, and we need 
to celebrate my husband's 50th birthday on Sunday because 
after that I'll be hospitalized." And guess what? It turns out that 
you CAN make reservations for eight people! So cancer is a 
good news/bad news thing. Yes, you need toxic chemo — but at 
least now you can get dinner reservations! 

I booked us for the 7:30 set and finalized the plans for 
Steve, Q, and their kids to meet us there. I had casually 
mentioned to David earlier in the week that maybe we could go 
out to eat on Sunday for brunch or dinner. He said dinner is 
better because the kids need to do their homework during the 



day (I had been counting on him saying that). Emma overheard 
the conversation. After David left the room, Emma looked at 
me admiringly. "Mom, if I had a hat, I would take it off to you." 

When Sunday came, David was full speed ahead in 
superdrive mode to make sure that the kids got their homework 
done, and he said he wasn't sure we'd have time to go out to 
dinner. Emma was worried — what if we can't talk Dad into 
going? But I reassured Emma by reminding her of the line in 
My Big Fat Greek Wedding where the Greek mom says that the 
man of the house may be the head, but the woman is the neck, 
and she can turn the head whichever way she wants. 

Here's how it went down. About 5 :45 I was alone in the 
family room and David came in and asked, "Where are we 
going for dinner?" When I hedged, he began to suggest 
restaurants, and then he realized I had a plan. His face was 
apprehensive and his arms were crossed, something he does in 
the rare moments when he gets upset. He said he wanted me to 
tell him what's going on, because he can't deal with any more 
surprises after the shock of my diagnosis. I told him that I'd 
made a surprise celebration for his 50th birthday, that we had 
reservations at the Jazz Standard, that Bill Charlap was playing, 
that the Berkowitzes were going to meet us there, and that there 
would be cake and presents. David looked puzzled, like he 
didn't understand. He asked, "How can I celebrate my birthday 
and be happy in the middle of all of this?" 

I explained it to him. I told him how much fun it had 
been for all of us to plan this wonderful dinner, how the kids 
had been bumping into each other for two days trying to keep it 
a secret. I told him that we can't make the next six months of 
our lives all about the cancer. That one of the things that will 
get us through this is to find the moments in our lives that 
deserve to be celebrated and to celebrate them. That he was 
having a birthday, and that Emma is going to Paris for her 



spring break, that Nate survived the SATs, that I finished 1 of 
my 18 chemos (only 17 left!), and that after 24 years of 
marriage we're still together. 

We got in the cab, and Nate gave the driver the address. 
The Berkowitzes met us in the narrow entry way of the jazz club 
and I said: "Recipe for instant party: add four Berkowitzes, and 
let the fun begin!" The eight of us went downstairs to the dimly 
lit foyer. The restaurant had a sprinkling of small tables and 
booths with an elevated stage in the front, and the walls were 
covered with signed photographs of jazz giants who had played 
there in the past. They seated us at a table with a long curvy 
booth on the left and cushioned chairs on the right, so we could 
all be comfortable. David and I were in the middle of the table, 
between the senior Berkowitzes and all the kids. 

One of the most wonderful things about the party was 
how we're all so close — some of us got up and moved around 
to different seats, so by the end of the evening, everybody had 
talked to everybody. It's so rare in relationships among eight 
people that all of the possible combinations work, but with our 
two families, they always have. Good food, great music, and 
then they brought out the chocolate cake that said "Happy 50 th 
Birthday David" that we had pre-ordered with one candle. I 
decided not to put in 50 candles, remembering the debacle of 
the waxed cake from David's college days. 

I couldn't resist making a little speech. David is always 
teasing me about how I tell the long version of the story, never 
the short version. He likes to tell me the Colin Quinn joke about 
his girlfriend telling him an interminable story with every 
possible detail included, and Colin says to her, "Excuse me, but 
I don't want to live your life in real time!" I kept my remarks 
short and sweet. I thanked everyone for coming and said how 
glad I was that we could all be here for David's birthday. Then 



we drank a toast to wish David a happy birthday — the boys did 
it with Coke, and Emma had a sip of champagne. 

At home, after the kids went to bed, David thanked me 
and said it was "good to have the distraction for the kids." But 
it's more than that. We live our lives too fast, and don't look 
around enough. I realized it once when I was dashing through 
the reef while scuba diving, as if I had to make some deadline. 
You're in the water and the coral reef is magnificent; you might 
as well enjoy the view. The good things are not a distraction. 
They're the point. David has been saying that for years, and I 
believed him in theory, but didn't really live my life that way. 
I'm finally getting it. It's ironic that I'm teaching David the 
lesson he's been trying to teach me for three decades. 

On another note — I can't believe you and Sophie 
watched The Devil Wears Prada last night — Emma & I were 
watching it too! We just got the DVD. We had seen the movie 
in the theater in Hilton Head this summer — but the problem 
with seeing it in Hilton Head is that it instills in you the longing 
to shop in New York, which is tough to do when you're in South 

Tomorrow I'm going to work, and then Tuesday 
intrathecal methotrexate. If they can't find the Omaya this time 
I'm going over to the mammo office so Cindy can do an 
ultrasound and draw a big arrow on my head. 


From: Laura 

Sent: Tuesday, March 20, 2007 5:29 AM 



To: Jennifer 

Subject: The Prednisone Diaries 

Hi Jen. This may be the last installment of "The 
Prednisone Diaries" (3-5 am version) for awhile. Today will be 
my last day of oral prednisone for this cycle. I take it for the 
first 5 days after the R-CHOP, and today will be day 5. And 
darn, I had hoped I'd get the whole apartment cleaned while on 
that steroid rush! Imagine how clean Mark Maguire's apartment 
must be. 

Yesterday was the first day I really went back to work 
since the surgery. It was a Monday, and on Mondays and 
Wednesdays I direct the Program for Women Faculty Affairs. 
I'd love to show you my office. After you go in the front door, 
there is a kitchen to the immediate right, and past the kitchen is 
the door to our suite. My office has a desk, bookcases, a round 
table that can fit three chairs easily, and a window overlooking 
some trees on the street, my first office window in over 1 7 

I had a bunch of stuff to do in the office, but I took it 
slow. I had to finalize some details for this Wednesday's 
breakfast meeting of Athena, which is our informal group for 
women faculty. We call this group Athena after the Greek 
goddess of wisdom and war. In Homer's Odyssey, Odysseus 
asks a wise and trusted old man named Mentor to take care of 
his son Telemachus when Odysseus goes off to fight the Trojan 
War. It turns out it is actually Athena, a woman and a goddess, 
disguised as Mentor, who guides Telemachus in the Odyssey. 
We thought Athena was the perfect name for a group of women 
faculty who offer each other support and guidance. 

Cindy came to see me in the Women's Office. She 
brought me a maroon baseball cap that said "Monk," after the 
detective with obsessive compulsive disorder (OCD) who is the 



hero of my favorite TV show. Monk's OCD makes him a great 
detective, because he notices everything, but complicates his 
life because of his many phobias and rituals. Cindy is a cancer 
survivor, and last year, when she was recovering after surgery, I 
sent her a collection of Monk DVDs. It seems right that now 
that I have cancer, she gave me a Monk cap. A few other friends 
had sent gifts to the office. One of the good things about having 
cancer is that people are always giving you "cancer presents." 
It's like Christmas in the spring! 

I figured out a plan to structure my days for the 
immediate future. On Mondays and Wednesdays if I'm up to it, 
I'll go to the Women's Office. The other days, if I'm not getting 
treated or hospitalized, I'll go to my Radiology office to do 
some administrative work or research. I'll aim to leave work at 4 
pm, so I can be here when the kids get home from school. Jen, 
I'm almost 47, my kids are 17 and 14, and yesterday, when they 
came home from 1 1th and 9th grade respectively, I got to 
offer them milk and cookies and ask them about their day at 
school. Finally! 

When I got home yesterday, I talked to Carmen. I asked 
her how she thought the kids were doing through all of this. She 
said that it's hard on them but they'll be OK. She told me how 
much time the kids spend with each other at home these days, 
talking in Nate's room with the door closed. I was relieved to 
hear it. How wonderful if they can support each other. Around 
4:30, the kids came home; Emma settled down to schoolwork 
and Nate closed the door in his room to take a nap. 

I went to the laptop to write; Carmen gave me a hug and 
left. The laptop is on the dining table in our living room, which 
we redecorated since you last saw it. It still has bookcases on 
most of the walls, the dining table on the near right, and the 
piano on the left. We got shades to cover most of the glass 
windows on the far side of the living room, but left bare the 



glass door that opens onto the terrace. We bought a big Oriental 
rug. We also replaced the old couch with an oversized sofa that 
has big stuffed pillows and got two comfy "glider" chairs in 
muted colors with a hint of turquoise. I love to sit in one of the 
gliders and read and listen to David playing the piano. Around 6 
pm, the kids emerged from their rooms, hungry for dinner. 

We ordered dinner from a neighborhood Italian place 
called Arturo's, one of our family favorites. I called David on 
his cell to ask what he wanted me to order for him, and he was 
glad that I was home. We had a family dinner for a change, and 
then the kids escaped to their homework. That little extra time 
with the kids when they get home from school and having 
dinner all together felt like a gift — I usually don't get home 
until after seven. Later I told David that for the next few months 
I would try to get home before the kids whenever possible, and 
he said that sounded like a good idea. 

Today they're going to make a second attempt to give 
me intrathecal methotrexate in the Omaya. David asked me 
what time the appointment was so he could reschedule his day 
to come with me, but I don't want to drag him to all my 
appointments. He has to work, take care of the kids, and handle 
the logistics of our lives. If I really need him, like I did when I 
had brain surgery, I won't hesitate to ask, but if it's not 
essential, I'd rather conserve his energy. Cindy offered to come 
with me and sounded like she meant it, so I think I'll take her up 
on it. 

The prednisone buzz is fading, and I may go back to 
sleep for a little while. 

More tomorrow. 




From: Laura 

Sent: Tuesday, March 20, 2007 1 1:14 PM 
To: Cindy 
Subject: Oh Me Omaya 

Hi Cinderella. Just a note to thank you for your starring 
role in the drama "Oh Me Omaya." I appreciate your coming 
with me for the intrathecal injection today. You were exactly 
the right person to be there for me when I needed you, and I will 
never forget it. 


From: Laura 

Sent: Wednesday, March 21, 2007 6:26 AM 

To: Jennifer 

Subject: Intrathecal chemo: it worked! 

Hi J. Yesterday I went to the hospital for intrathecal 
chemo. The neurosurgeon made his guest appearance and 
showed the oncologist where to go. Cindy came with me. I 
figured since she's expert at using the numbing spray from 
having participated in thousands of breast localizations, she 
could jump up and spray my head if necessary. 

I instinctively reached out to Cindy, and she was a good 
choice. We started at Memorial around the same time 17 years 
ago, when I was a fledgling radiologist and she was a breast 
imaging technologist who worked with our mobile van 



mammography screening program. Since that time, she has 
risen through the ranks and is now the Chief Technologist of 
Breast Imaging at Memorial Hospital. You haven't met her — 
she has blonde hair and looks like Cameron Diaz. In fact, before 
she became a radiology technologist, she used to be a hand 

Cindy and I seem to be there for each other at key 
moments in our lives. Two years ago I came to the office on a 
vacation day morning to tidy up some loose ends. I called Cindy 
in the mammography office about some work-related issue, and 
she told me she had a new breast lump. I read her mammogram, 
did a breast ultrasound and a needle biopsy that day, and 
referred her to the breast surgeon who cured her breast cancer. 
And now Cindy's there for me. 

When I introduced her to my oncologist, I said "This is 
Cindy, the Chief Technologist in Breast Imaging" and he asked 
her, "Can you help me schedule a mammogram on one of my 
patients?" Without missing a beat, Cindy said, "Sure, but only if 
you get this tap on the first try!" Go Cindy! I could have kissed 
her feet. They got it and gave me the chemo. I felt nauseated 
afterwards and had to lie down. Cindy was great — she stayed 
with me and held my hand while I was getting the chemo and 
took me home in a cab. When we were in my building, Cindy 
took me upstairs; I introduced her to Nate, Emma, and Carmen, 
and then I went to lie down. 

Now I have to go, because we're having an Athena 
breakfast 7-9 am today to celebrate recent women's 
appointments and promotions. If I feel up to it, I'll stay at work 
for awhile afterwards; otherwise, I'll come home, and go back to 
sleep. Phil, the oncologist, wants to give me intrathecal twice a 
week (Tues/Thurs) for the next 3-4 weeks, until the CSF 
"clears" (which means has no more malignant cells), and then 
we'll see. 




From: Laura 

Sent: Thursday, March 22, 2007 2:16 AM 

To: Jennifer 

Subject: Athena breakfast 

Hi Jen. The Athena breakfast yesterday was OK. We 
have these Athena events once a month. We usually meet from 
5-7 pm, but sometimes we have an early breakfast or lunch, so 
that women with different schedules can come. Athena is a 
chance for women faculty and administrators from MSKCC to 
meet informally. Before each Athena, I get a list of all the 
recent women faculty appointments and promotions (A&Ps), 
and then I invite those women to Athena to celebrate. We get 
RSVPs so we know who's coming, and we have a little 
celebration in which we give each of them a flower. The event 
is pretty low-key — people filter in and out as they can. 

For the breakfasts, we order food for the number of 
people coming and it's served buffet style. I usually get there 
around 7 and put in the CD with the background music. We mill 
around and eat and chat until 8, and then I take 10-15 minutes to 
make announcements. I was supposed to be there at 7 today, 
and actually was up before 6. 1 had showered to go, but then I 
felt sick, all sweaty and nauseated and faint, and I had to lie 
back down. David was surprised — "Weren't you going to get 
up?" he asked. When I told him I didn't feel well, he helped me 
crawl back into bed. I asked him to wake me up so I could be at 
work by 7:45. 



When he woke me up at 7 am, I felt better. I showered 
again and put on nice clothes — a flowing skirt with rust and 
green flowers, a green shirt, a little green jacket, and my 
favorite green hat (from Banana Republic). I haven't started 
losing my hair from the chemo yet, but my head still looks 
pretty scary, so I'd rather keep it covered. I took a cab to the 

When I arrived, about 20 women were there already, and 
the breakfast buffet was out. Usually we get a continental 
breakfast, fruit and bagels and pastries, but today we decided on 
real food — scrambled eggs and home fries. When I entered, 
people seemed glad to see me. I told them I had brought the 
background music, and offered them a choice of Murray 
Perahia playing Mozart Piano Concertos or the Beach Boys 
Greatest Hits. And guess what? We went with the Beach Boys! 
That was my first choice too — the Beach Boys got me through 
the first round of chemo. 

After "California Girls," I got up to make the 
announcements. Usually I stand at the podium, but when I stood 
up I got lightheaded and dizzy, like I do when I'm dehydrated 
after spending too much time on the beach in the hot sun, so I 
sat down. The other women sat in circles at adjacent tables. I 
made the announcements, which, in another deviation from the 
norm, I had written out in advance. 

"It has become our tradition at Athena to celebrate 
women faculty achievements at MSKCC, particularly 
appointments and promotions," I said. "We are blessed to work 
at the greatest cancer hospital in the world. We save lives, and 
take away fear, and discover cures, and make the world a better 
place. And these activities keep us busy, and impact on the rest 
of our lives. It is important in the midst of all of this work to 
take a moment to celebrate our achievements and congratulate 
each other on our successes. 



This seems particularly important to me now. As many 
of you know, I was recently diagnosed with lymphoma and am 
being treated here at Memorial. I need six months of 
chemotherapy, and have already finished two treatments. This 
experience makes me believe even more strongly that we need 
to savor special moments in our lives as they come. So today 
we continue our tradition by welcoming women newly 
appointed and congratulating women recently promoted at 
Memorial. Please join me in the following celebrations..." 

We celebrated each woman's new appointment or 
promotion by giving her a flower. We passed around a hand- 
held mike, so that each woman being honored had the chance to 
speak. I was touched when a terrific surgeon thanked me for my 
help with her promotion package and my work with women 
faculty. Then we went back to milling around. I got faint and a 
nice pediatrician named Yasmin took me home in a cab. 

I lay down most of the morning, and must have napped 
off and on. When I woke up, Carmen was there. I guess she's 
my nanny now. She was so sweet — she got me water and made 
me herbal tea. After that I fell asleep for real. By the time I 
woke up, it was dark outside, and the kids had come home. 

Emma had decided to help find me the Zen. She went to 
Barnes & Noble after school and bought me my own Itty Bitty 
Buddha, a tiny reddish portly gentleman with gynecomastia 
(male breasts) and a protuberant belly which apparently brings 
you luck when you rub it, so rub away I did. Carmen made us 
dinner, David came home, and Carmen left. I hung out with 
David and the kids between naps. Emma and I watched the 
latest installation of America's Next Top Model, and we agreed 
that we both hate Renee, although she did take a good picture of 
being dead. 

This afternoon I have to get another dose of intrathecal 
chemo. Cindy will come with me again. 




From: Laura 

Sent: Friday, March 23, 2007 6:19 AM 

To: Jennifer 

Subject: More intrathecal chemo 

Dearest Jen, 

Notice, first of all, the luxuriously late time on this 
email — it's after 6 am now! It's hard for me to think that only a 
few months ago, I would have thought 6 am was early. I woke 
up at 2 am as usual but had some herb tea and a piece of banana 
bread that Q had bought for me and went back to sleep, 
listening to the Brahms Clarinet Trio that you and I used to play 
with Susan, the clarinetist, before she moved to New Jersey. I 
woke up again at 5 am, showered, took my pharmacy of 
morning meds, made more tea, had a piece of fruit (not bad 
nutrition considering the chemo, right?), and now I'm here 
writing to you. 

Yesterday was a busy day — two appointments, 
neurosurgery staple removal at 1 1 am and intrathecal 
methotrexate at 3 pm. I had been a little worried about the staple 
removal — I figured it would hurt. I wanted Cindy to come with 
me for the intrathecal chemo, and I didn't want to ask her to 
come to both. I asked Q to come to the neurosurgery 
appointment, although I was afraid it might be too graphic for 
someone who doesn't work in the hospital, and I figured I'd 
probably kick her out when the neurosurgeon came in. But it 
was actually fine — removing the staples took about a minute 
and didn't hurt at all — it was like taking out a barrette! My 



neurosurgeon is terrific. I asked how a nice Jewish boy from 
Tennessee like him got interested in brain surgery, and he 
replied, "Well, I couldn't sing." 

After the staples were out, Q took me home in a cab and 
came upstairs. Carmen was here by then and had cleaned the 
place and opened the windows and terrace door, so there was 
fresh air in the apartment. I lay down on the couch and rested 
while Q and Carmen made lunch. Q had bought me delicious 
chicken soup and a soft roll from the Vinegar Factory, which 
was perfect. And then Q left. 

I called my older brother; I'd been meaning to call him 
for days. He seemed apprehensive until I said to him, "So now 
I've had brain surgery and they're putting chemo into my brain, 
and I'm still smarter than you!" He laughed, relieved. If I could 
still talk trash, I must be OK. I asked him to look after our 
mom, who lives near him in Massachusetts. We had a nice but 
brief chat until Emma came home. I talked to Emma for a few 
minutes about her day in school, and then it was time to for 
intrathecal chemo. 

I met Cindy there around 3. They checked my blood 
counts with a quick "finger stick," meaning they just prick your 
fingertip with a needle. After the results came back, I went in 
for more intrathecal chemo. The procedure went fine, but 
afterwards I felt nauseated and I vomited. Wonderful Cindy 
held my hair back so I wouldn't puke all over it. And another 
thing I've noticed (as long as I'm using my experience as a 
patient to revolutionize patient care): have you ever wondered 
why those tiny little barf basins are so small? Because when 
you're throwing up, what you really want is not just to puke, but 
to have to hit a very precise tiny little peanut-shaped target. I 
asked the nurse, since we're the finest cancer hospital in the 
world, don't you think that maybe we could spring for the larger 
basins? Am I the first puking person to ever want a wider net? 



I sat with Cindy for a long time. She is brushing up on 
her "Reiki" which is a kind of massage that is supposed to have 
a healing touch, and it helps, or she does, or both, I don't know 
which. Then we went downstairs. I sat in the lobby (68th 
between 1 st & York) while Cindy got a cab. 

A physician colleague named Cheryl walked by. I was 
still nauseated, and had my head between my knees, trying not 
to throw up again. Cheryl asked how I was, and I told her I had 
just had chemo and thrown up, and she said, "Have you talked 
to other patients who have had similar experiences?" I replied 
that in the 17 years I've been working here, I have talked to a 
few cancer patients. And she said, "No, I mean now, as a 
patient? Maybe you should join a support group." I'm sorry, I 
know she means well, but here's some advice to people who 
want to help: if your friend with cancer is about to puke, don't 
refer her to a support group. Just give her a bucket. 

Cindy got me a cab (just in the nick of time — I was 
going to use my last reserve of energy to strangle Cheryl), and 
she slid in and I climbed after her. When I got home, Nate and 
Carmen were there and then Emma came. I lay down on the 
living room couch with the TV on. Nate covered me up with a 
fuzzy green blanket and I fell asleep. 

So the intrathecal methotrexate is a bitch. They want me 
to take nausea meds before my next treatment on Wednesday. 
On Thursday I get admitted for the IV methotrexate, which is 
supposed to be the hardest of all. Phil says I'll be in the hospital 
at least five days. My spirit can take it but I hope my body's up 
for it. Bring it on. 



Chapter 5 
Hats and Silver Linings 

Look at this as an opportunity to get new hats. 

From: Laura 

Sent: Friday, March 23, 2007 2:03 PM 

To: Jennifer 

Subject: Hats 

Dearest Jen, 

Where do I begin to tell the story about the hats? (Love 
Story music in background.) 

Maybe I should start with the diagnosis of cancer, when 
I realized that I should look upon this not as losing my hair but 
as an opportunity to buy new hats. And then maybe 111 skip to 
the point where Emma & I went on-line to look up hats, and 
found the most beautiful hats I'd ever seen, made by a woman 
named Christine A. Moore. When I looked up her website, I 
found she has a studio in New York. She answered my phone 
call herself. "Christine?" I asked. "Yes?" she replied. "My name 
is Laura," I explained. "I'd like to come and see your beautiful 
hats." She said, "Are you a buyer for a store?" I told her that 
I'm a doctor in a cancer hospital who just became a cancer 
patient, and if I wear her hats and look fabulous, she will sell a 
lot of hats. She inquired, "What time would you like to come 
in?" We arranged it for today at 10 am. Just in time. My 47th 
birthday is tomorrow, the day my beautiful Emma is going on a 
class trip to Paris. 

Yesterday I called Christine to confirm. Her address was 
near Macy's on the West Side. Although I had a tough time 



with the intrathecal chemo yesterday, I slept better last night 
than I have in a long time. I fell asleep around 10:30, and woke 
up as usual between 2 and 3 am, but I listened to Carole King's 
"Music," which struck me as incredibly rich and melodious. I 
fell back asleep until after 7. Then I got up, showered, and was 
ready when Emma awoke. 

Emma was wearing a grey and white striped shirt and 
ripped jeans. I had on a skirt and blue shirt, and wore a brown 
hat we picked up at Bloomingdale's last week. We buzzed for a 
cab and our favorite car service driver, Mischa, was there. He's 
a Russian immigrant who enjoys practicing his English — every 
time we drive with him he has incorporated some new big word 
into his vocabulary. He drove us to Christine's. 

We took the small elevator up, and there were white 
halls with white doors, each one a different place of business. 
When we knocked on Christine's door, a young woman 
answered who said she was Christine's assistant. Jen, the place 
was perfect. Her studio was small, about the size of the first 
office I ever had at the hospital, with hardwood floors and white 
walls. All around us were a million wall hooks and hat stands, 
and every available space was covered with hats. There were all 
the hats I had seen on line and even a few more hats that are for 
her new spring collection. The hats were in every color of the 
rainbow, in every possible style and a million different fabrics. I 
said to Emma, "Oh, Emma, we've come to the right place." 

Christine entered. She was about my age, long dark 
straight hair, tall, nice smile. She told us that she was inspired to 
go into the hat business by her love for the theater when she was 
young. Christine also said that people talk to people who wear 
hats. I said, "That's good, because I want people to talk to me!" 
and she said "Me too!" We turned our full attention to the hats. 

I tried on hat after hat. I had studied the hats online and 
knew a lot of their names, which impressed Christine. I tried on 



some of the hats I recognized and others that I hadn't seen. The 
hats differed in the crown (shape of the top), material (straw or 
fabric, including silk, cotton, a fine weave, satin, or a sort of 
rain-proof material), brim size (small, medium, large), brim 
direction (neutral, up, or down), and trim (band, bow, flowers, 
feathers, combination, or none). Some hats sat higher on the 
head than others; after I lose my hair, the ones that sit lower will 
be better. 

I tried on the Easy and the Davenport and the Roz and 
the Natasha and the Reese Paisley and the Lucy and the Ruby 
and the Butterfly, and some cotton hats whose names I don't 
remember, and the Lachlan and I don't even know what else. 
Turquoise and rust and brown and black and tan and white and 
pink and gray. Across the room, I spotted a hat in a beautiful 
shade of purple with a big flower. I had to get that one. I said to 
Christine, "With a hat like that, I have to win." 

By the end, I had ordered 15 hats! After we paid, 
Christine asked if she should ship them, and I said yes. She's 
shipping them on Monday; they should arrive on Tuesday. 
When Emma is in Paris on Tuesday, she will know that 
somewhere in New York I am getting a huge delivery of 
beautiful birthday hats in huge white hat boxes tied up with big 
yellow satin ribbons. 

At the end, I gave Christine a big hug and she asked me 
what kind of cancer I have. I told her it was lymphoma. She 
asked how far along I was in the treatment. I replied that I'd had 
neurosurgery already, and had received three of 1 8 chemo 

I got the hats for a lot of reasons. I did it because I like 
to look for silver linings. I did it to teach Emma that even when 
life is hard, you can do things to make it better. I did it because 
it gave me something wonderful to think about for the past few 
days as I started chemo. And I did it because it will help me 



beat this. Because honestly, Jen, how can I lose the battle with 
cancer if I'm wearing a hat like that? 


From: Laura 

Sent: Friday, March 23, 2007 3:19 PM 

To: Cindy 

Subject: Balloons! 

Hi Cindy and "Breast Friends" (Cindy, can you forward 
this to all co-conspirators?)! 

I'm writing to thank you for the incredible bunch of pink 
balloons that you sent. I have never seen so many balloons in 
one place. They are a fabulously happy birthday present, and 
will be even more therapeutic than the chemo. Thanks! 


From: Laura 

Sent: Saturday, March 24, 2007 4:23 AM 

To: Jennifer 

Subject: Birthday balloons 

Hi Jen. Happy birthday to me! Yesterday after Emma 
and I got home from the hat shopping, we were resting in the 
family room and the doorman buzzed, and came up with a huge 



bouquet of balloons in different shades of pink, all helium- 
filled, with long twisty pink ribbons that came together tied to a 
weight with a pretty bow at the bottom. The balloons (which 
were from the "Balloon Salloon," I kid you not) could barely fit 
through our front door! The gift was from Cindy and the other 
breast folks. They had wanted to throw me a party on Monday 
but I wasn't up for it — the balloons were the perfect birthday 
gift. Emma and I laughed, and even the boys laughed about it 
when they got home. 

Emma is going to Paris today for spring break, and 
David has been working hard to get everything ready for her. 
He also had to do our taxes, and is dealing with legal stuff for 
us. The kids were both out for awhile last night with friends, so 
David and I had a little time together. We sat and listened to 
Bill Evans and made a list of things to do, and then we curled 
up to watch the Hitchcock movie with Cary Grant and Grace 
Kelly, To Catch a Thief. 

Keep writing. What music are you playing now? 


From: Laura 

Sent: Saturday, March 24, 2007 9:38 PM 

To: Jennifer 

Subject: Birthday 

Hi Jen. Thanks for the wonderful Blue Mountain 
birthday card! And that's terrific that you're working on the 
Bach Suites for Unaccompanied Cello. I have a recording of 
Yo-Yo Ma playing them on my iPod, and it's one of my 



favorites — especially the first part (prelude) of Suite 1 in G 

I had a fabulous 47 birthday. I went back to sleep after 
I wrote to you, and I felt good when I woke up. It was beautiful 
here, sunny and just a little cool. Emma woke up first. I 
snuggled with her in bed and she told me about a party she went 
to with her friends last night. David woke up and we awakened 
Nate, who likes to be at the soup kitchen where he volunteers by 
1 am. We all had breakfast together — David made scrambled 
eggs and home fries. Thank God Emma inherited her cooking 
talent from David, not from me. When we were in college, I 
was a better cook than David, but then he met a guy in his 
medical school class who was a gourmet chef on the side and 
taught David everything he knew. 

Today, to celebrate my birthday, we separated the pink 
balloons from their attached weight so that the balloons could 
fly all over the apartment. We played an impromptu game of 
balloon volley ball, and David and the kids let me win, because 
I'm the birthday girl. Emma tied four balloons to the glass at the 
top of the walls on our terrace. They look festive, especially 
since it's a little windy and the balloons are dancing in the 

The family did the traditional "Showering of the 
birthday person with gifts," in which the rest of the family 
practically trips over each other to keep a secret of the wrapping 
of presents and the signing of cards, and a bag is brought to the 
"surprised" guest of honor (who is never quite surprised). They 
gave me gifts I'll definitely use: books by Perri Klass, a woman 
doctor who is one of my favorite writers, and CDs to put on my 
iPod (Glen Gould playing Bach Goldberg Variations, the album 
from the Producers, and an amazing jazz guitarist named Nino 
Josele playing the music of Bill Evans). Nate went to his 



volunteer gig, and Emma and David finished packing for her 

David had rented a car to drive Emma to her school 
today, because the kids going on the class trip were all meeting 
there to take a bus to JFK for their trip to Paris. I wasn't sure I'd 
be up for the car ride, about an hour each way, but it was a 
gorgeous day and I felt good so I went. Emma was the first 
student there. We met Emma's French teacher, and then Emma 
took us on a little walk on the beautiful campus and showed us 
her favorite deli for lunch where they name their sandwiches 
after superheroes. We were unanimous — we all wanted the 
Batman, which has turkey, honey mustard, and slices of green 
apple. After a quick lunch we walked back up the hill to her 
school, helped Emma get her bag on the bus, and waved 
goodbye. She went off to Paris. 

I finally get the secret of living a good life. You have to 
create your magic in each individual day. Today, for example, 
there was the birthday and the balloons and seeing Emma off; 
yesterday we got the hats; and last weekend we had David's 
birthday party. There's always a lot of shit that will either be 
prescheduled or will happen spontaneously. The way to make 
the balance good is to pack in the good stuff too. I bet that 
advice is in every self-help book I've ever read and ignored, but 
somehow I get it now. Even on the days when I have chemo or 
something else that sucks, I can build some magic into it. 
Maybe in this book I can express that in a way that will help 
people understand. You shouldn't have to get Stage IV 
lymphoma to figure it out. 

Got to go. Energy is fading. Nate had a friend over for 
awhile and they watched March madness (college basketball) 
on TV. Since UCLA beat Kansas, Nate is leading his NCAA 
bracket now. Life is sweet. 




From: Laura 

Sent: Sunday, March 25, 2007 7:41 AM 

To: Emma 

Subject: To Paris from New York 

Hi Emma. It's Sunday morning and I'm in the living 
room, writing to you from the lap top. I slept well and feel 
good. Half the birthday balloons are still as high as the ceiling, 
and the other half have sunk to about my height. A few are 
almost on the floor. How many days will it take all of them to 
come down, I wonder? The balloons that you tied to the terrace 
walls are still there, dancing in the breeze, but now they are just 
slightly higher than eye level. I like to see them because they 
remind me of you. 

I love you more than the sun, the moon, and the stars. 

Can't wait to hear about your trip. 


From: Emma 

Sent: Sunday, March 25, 2007 12:34 PM 

To: Mom 

Subject: From Emma in France 

Dear Mom, 



There's a computer in the lobby of this hotel that I'm 
using to write you this email. All the computer commands are in 
French! I should be able to get back here tomorrow, but I'm not 
sure, and I have no idea whether or not the hotel in Paris has a 
computer. The flight was good. I slept on the plane for a few 
hours. Tell Dad that bringing extra contacts was a brilliant idea 
because I could take them out before I fell asleep and put new 
ones in when I woke up. 

After we got off the plane, we went to a part of town 
where we walked around, shopped, and ate. I had a brie, tomato, 
and watercress sandwich on baguette and a waffle with bananas 
and chocolate. I also took a lot of amazing pictures and I'm 
worried that I might not have enough space on my camera if I 
keep taking around 250 pictures a day. 

Sun Moon Stars 



From: Laura 

Sent: Sunday, March 25, 2007 4:47 PM 

To: Emma 

Subject: Love to Emma in Paris 

Dearest Emma, 

Thanks for your email! Now you understand how I used 
to feel when I was traveling a lot for work, and my biggest 
challenge of each day on the road was to figure out how to get 
to the next computer so that I could send and check email. Don't 
worry, I'll assume it may be days before you get to check it; if 



there's anything urgent, Dad and I can get in touch with you 
through your French teacher. 

It's still a beautiful Sunday. Dad was out for most of the 
morning to round on his patients at the hospital and then he 
went grocery shopping. Nate and I talked about a short story 
he's reading for English by Melville called Bartleby the 
Scrivener, about a man named Bartleby who works as a "scribe" 
or copyist for a lawyer, and whenever anyone asks him to do 
anything, he says, "I would prefer not." Nate has to write a 
paper about it, so that's what he's doing today. 

I love that you're taking so many pictures. When we 
went on our family trip to Paris a few years ago for Aunt 
Laura's "end of chemo celebration tour," I took a million digital 
pictures too — do you remember? I had to spend hours 
downloading them each day so I would have enough memory 
on the camera to take more pictures the next day! Thank 
goodness for those electrical adapters. 

I'm so glad Elena is your roommate. I know you hoped 
she would be. And I really love her parents — they're always so 
nice at school events, and I liked talking to them at your recent 
basketball game. 

I've been listening to French music in honor of your 
being in Paris. There's a beautiful sonata for clarinet and piano 
by a Parisian composer named Poulenc that I used to play in 
chamber music class with my friend Susan, who was a 
wonderful clarinetist. The sonata has three movements: allegro 
tristamente (fast and sadly), romanza tres calme (romantic and 
very calm), and allegro con fuoco, tres anime (fast with fire, 
very animated). We can listen to it together when you get home. 

G2G (see? I listened when you taught me that G2G 
means Got To Go). Going to take a nap. I love you so much. 



Sun Moon Stars 



From: Laura 

Sent: Tuesday, March 27, 2007 1:07 AM 

To: Jennifer 

Subject: Liberation 

Hi Jen. Don't worry that you and Sophie had to interrupt 
your shopping because she was fussing. It's OK that Sophie is 
not an Olympic shopper yet. Emma took awhile to grow into 
her profound love of shopping, and now she is everything I 
could have dreamed of in a shopping companion and more. 

Monday was fine. I went to the office. Cindy organized 
a birthday lunch for me with all the techs — chicken vegetable 
soup and vanilla frozen yogurt, two of my favorite foods. I went 
home to Nate by 4 pm, and we made a game of guessing how 
many days it would take for all of the balloons to fall down. The 
person who guesses closest without going over is the winner — 
no prizes, just the satisfaction of success. Some of those 
balloons are still hanging up there by the ceiling! The ones that 
fall we either throw away, puncture, or "liberate" — we go onto 
the terrace and release the balloons into the sky. The balloon 
liberation was Nate's idea — at first I was going to discourage 
this practice because I was concerned about its impact on global 
warming, but then I thought hey, it looks like fun 




From: Laura 

Sent: Tuesday, March 27, 1 1 :26 PM 

To: Jennifer 

Subject: Cornell trip 

Dearest Jen, 

Let me tell you about this amazing adventure Nate & I 
had today. Last week we had to fill out some forms for Nate's 
college applications, and on one of the questions they asked if 
we had any personal ties to specific colleges. David and I wrote 
about where we went, but then Nate asked me, "Mom, aren't 
you a professor at Cornell or something?" and I realized that 
yes, I am! Along with my faculty appointment at Memorial, I 
have a medical school appointment at the Weill Medical 
College of Cornell University. Here I am, always advising the 
women faculty to be aware of all of their appointments, and I 
don't even remember my own! That got Nate thinking about 

We planned a day trip to visit Cornell. It had to be 
today. Tomorrow (Wednesday) I get intrathecal chemo at 3 pm 
and Thursday I'm admitted for inpatient chemo, so this is my 
narrow window. We arranged to take a flight from LaGuardia to 
Ithaca that was supposed to take off at 8:30 am and land at 10 
am. We planned to take a tour at either 1 1 am or 1 pm 
depending on exactly when we get in and stroll around the 
campus. I also booked a hotel for the day (they have a hotel 
school at Cornell, so they actually have a real hotel called the 
Statler right on campus) so that if I get sick or tired I could 
sleep. We booked the return flight for that evening from Ithaca 
to LaGuardia. 



The day deviated from the plan. We got on our flight, 
but the plane sat on the runway for 45 minutes before it took 
off, and then they couldn't land in Ithaca because of fog. We 
circled in the sky for over an hour, and finally they landed in 
Syracuse at 1 1 am. So much for the 1 1 am tour. By the time we 
got to the Cornell Admissions Office in Ithaca, it was 1:15 pm, 
and the 1 pm tour had already left. Nate and I were both tired 
and hungry by then, so I suggested that we just go to the hotel, 
dump our stuff, have lunch, and explore the campus ourselves. 

The Statler Hotel was right next door to the admissions 
office, and it was like a quaint country inn. I had booked a room 
on the 9 ! floor with twin beds so we could both lie down if 
necessary and have our own space. Jen, the view of the campus 
and mountains from that 9th floor window was breathtaking. It 
was worth the whole trip just to see that view. Nate and I pulled 
up two chairs to the window and looked at the map of Cornell, 
and Nate figured out which building was which. We ordered 
room service for lunch. I got tired after lunch and took a nap 
while Nate went off to explore on his own. 

When I woke up two hours later at 4:00, the sun had 
come out. The first thing I saw was the panoramic view of the 
campus, including an old clock tower with bells that chime like 
a European cathedral every 15 minutes. I got up and splashed 
some water on my face and at that moment, Nate walked in. He 
had explored and procured us ice water and fresh fruit. I asked 
him to take me on a tour, and he gave me the short version: two 
stops and three breaks. We went to the James Olin library and 
the Cornell store, and Nate bought Cornell t-shirts for the whole 
family. After a quick dinner at the hotel, we went back to the 
Ithaca airport and took an uneventful trip home. 

The trip meant a lot to me. I was touched by the way 
Nate looked out for me. It was great to imagine him in that 
pastoral setting and to see his life opening up with possibilities. 



I liked helping him get familiar with the process of the college 
visit, so he can make some future visits on his own or with 
friends. Best of all, I loved the fact that we seized the moment 
between two chemos to do something special. I've since found 
out that my white blood cell count was essentially zero when I 
went. Breathing recirculated plane air is not a great idea when 
you have no white blood cells with which to fight infection, so 
I'm glad I didn't know my white blood cell count at the time — I 
probably would have been scared to go, and I would have 
missed it. 

Got to go to sleep) — out of juice. More tomorrow. 


From: Laura 

Sent: Wednesday, March 28, 2007 7:30 AM 

To: Jennifer 

Subject: Third time's a charm 

Hi Jen. Great news. You know how I've been vomiting 
like crazy every time they give me the intrathecal methotrexate? 
Well, today I didn't throw up! 

I was scheduled for my third dose at 3 pm. I had been 
taking a nap, and I forgot to ask Carmen to wake me up, so I 
almost overslept my doctor's appointment. Luckily I had 
arranged to meet Cindy at the oncologist's before 3. Thank God 
for Cindy — when she couldn't find me, she called me on my 
cell phone. I was the last appointment of the day, but Cindy 
convinced them to stay to give me the chemo. Good thing I only 
live ten blocks from the hospital. I jumped in a cab to Memorial. 



This time, the intrathecal methotrexate was much better. 
As Phil had suggested last week, I took some anti-nausea meds 
beforehand. There is a wonderful pill called Zofran that tastes 
sweet and melts in your mouth — which is perfect, because when 
you're nauseated, you don't really feel like swallowing anything. 
Unfortunately, Zofran costs about $40 per pill. Remember the 
episode of Seinfeld where Elaine is worried that the Today 
Sponge, her favorite form of contraception, may be 
discontinued? She buys a case of Sponges, which may be the 
last in existence, and before having sex with a guy, she has to 
decide if he's "sponge worthy." Well, when I'm nauseated, I 
have to decide if the nausea is "Zofran- worthy" or if one of the 
many cheaper nausea pills (like Compazine) would work. 
Intrathecal chemo is definitely Zofran- worthy. 

When Phil came in to give the intrathecal injection, 
Cindy jumped up to spray my head. Phil had trouble getting the 
needle into the Omaya, and encountered a fair amount of 
resistance to injection, so he had to inject very slowly. An 
injection that usually takes seconds now took a couple of 
minutes. I waited for the nausea, but it never came. I felt so fine 
that I asked Phil afterwards, "Are you sure you gave me the 
chemo?" Yes, he was. Maybe it was the Zofran, but I wonder 
whether the injection rate also has something to do with it. 
Could it be that a slower injection of intrathecal chemo is less 
likely to cause nausea and vomiting? I have to ask Sam, my 

First admission tomorrow. I'll write from "inside the 




From: Laura 

Sent: Wednesday, March 28, 2007 9:35 PM 

To: Cindy 

Subject: Thanks, and hats 

Hi Cindy. Thanks for calling me today to wake me up to 
get chemo, and for making them stay to give it to me. 
And guess what? The hats came! 



Chapter 6 
First Admission 

Get doctors you trust, and listen to their advice. 

From: Laura 

Sent: Thursday, March 29, 2007 1 1 :59 PM 

To: Nate 

Subject: Your visit 

Hi Nate. Thanks so much for coming to visit me on my 
first evening in the hospital. I take it as a good sign that there 
was a 5-episode marathon of The Office on TV. 

I'm delighted about the SAT. What a relief to know that 
you're done with that now. It's a huge weight off your shoulders, 
and one that you've been carrying around for months. Let it feel 
lighter — it is! 

The college thing will sort itself out. It's great that 
you're figuring out what you want in a school. You'll have a lot 
more information about all the schools by the time you make a 

Tomorrow is Dad's actual 50th birthday — can you make 
sure to wish him a happy birthday from me first thing in the 
morning, and give my love to Emma? 

I love you, Nate. 




From: Laura 

Sent: Friday, March 30, 2007 12:49 AM 

To: Jennifer 

Subject: First hospital admission 

Hi Jen. It was so wonderful of you to call and wish me 
luck the night before I was admitted. I was a little nervous about 
being hospitalized. I thought I was acting pretty cool about the 
whole thing, but you can see right through me, as usual. It just 
shows your insight into the human psyche (or at least into 
mine!). I like your suggestion that if I'm scared, I should just 
listen to Bach. 

Let me tell you today's chemo story. We got in at 9 am 
Thursday morning to admitting, and a woman named Sandy 
checked me in. We were supposed to wait for Escort but they 
took forever — now there's a shock! — so David and I jumped 
ship and went up to the eighth floor ourselves (I promised the 
woman in admitting that we would claim we snuck out and 
would never let on that she knew we were leaving). David 
helped me settle into the room here. We put my iPod and cell 
phone on a little table beside the bed, on their respective 
chargers. The room had a bed on which I spread a fuzzy green 
blanket from home, window with view, TV, DVD player, closet, 
private bathroom, and working hospital computer. I take the 
computer as definitive proof of the existence of God. 

The floor I'm on, M8, is the Bone Marrow Transplant 
(BMT) floor. Although I'm not getting a BMT now (that's plan 
B if the chemo is unsuccessful), sometimes lymphoma patients 
who are not getting transplants stay on this floor. Every patient 
gets a single room for two reasons. First, BMT patients are 
susceptible to infection, so they like to keep them isolated. 



Second, because the BMT patients are often here for long 
periods of time, sometimes up to two months or longer, most of 
the rooms are spacious enough that a family member can sleep 
over. Another thing that's good about being here is that if I do 
end up needing a BMT eventually, at least I'll be familiar with 
where it's going to happen. 

The nurse, Trish, accessed the port, which she did fairly 
painlessly, using the spray. We started with four hours of 
hydration using a salt solution (normal saline with bicarbonate), 
with the goal of making the urine less acidic and more alkaline 
so that the methotrexate won't crystallize in the kidneys. They 
check the urine pH, which is a measure of acidity, before giving 
the methotrexate — the higher the pH, the less acidic and the 
more alkaline, and you want the urine to be alkaline, meaning a 
pH of 7.5 or higher. Mine was 8 (I've always been an 
overachiever). When the urine is alkalinized, they run in the 
methotrexate, a large bag of ugly yellow stuff. 

One of the main complications of the methotrexate is 
painful ulcers in your gastrointestinal tract anywhere from the 
mouth (north) to the derriere (south). Trish told me that the best 
way to prevent those ulcers was by rinsing my mouth out 
frequently with a mouthwash called Biotene or with a 
bicarbonate wash. I did that every hour while I was awake. 

The night nurse, Jonathan, was very nice and knew what 
he was doing. I had no problems or reactions, and I've been 
peeing up a storm — the goal is 1 50 cc/hr and I am doing far 
better. They'll hydrate me more tonight and check another urine 
pH. If the pH is too low, meaning it's acidic, I'll need to take 
oral bicarbonate. 

Aimee, the ultrasound technologist from 64th Street, 
came to visit today with a card about how the Lord is walking 
by my side. When people ask what they can do to help, I say 
without hesitation, "Pray for me." I can't tell you how 



comforting it is to have people from all different religions 
praying for me. I have Jews writing my name on a piece of 
paper and sticking it in the Wailing Wall in Jerusalem and 
former radiology trainees in Croatia making pilgrimages. A dear 
friend of mine in New Orleans sent me a small wooden bracelet 
with pictures of the saints. I grew up in a reformed Jewish 
household and was never much of a believer, but somehow I 
feel that this positive energy in the universe channeled in my 
direction has got to help. And maybe there's more out there than 
we think. 

I love you very much. I know you will have an 
incredible son. It is so great to have a boy and a girl! 


From: Laura 

Sent: Friday, March 30, 2007 1:19 AM 

To: David 

Subject: Happy Birthday! 

Dearest David, 

(Imagine wild music in the background and a strip tease) 

Happy birthday to you 

Happy birthday to you 

Happy birthday dear David 

Happy birthday to you 

Are you 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 
17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 
34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50? 



(You can't be 50; to me we will always be college students, 
making love in a carrel in Baker library.) 

I think our boy and girl will both be OK. I love you 
today and every day. 


From: Laura 

Sent: Friday, March 30, 2007 2:23 AM 

To: Sam 

Subject: Update, and question 

Hi Sam. Just an update and a question. I tolerated the 
first IV R-CHOP without a hitch. I've had three courses of the 
intrathecal methotrexate. My first two intrathecal chemos were 
injected fast and I puked my guts out, but the third was injected 
much more slowly and it went fine. Does injecting the 
intrathecal chemo slowly decrease the likelihood of nausea and 

Best wishes 

From: Laura 

Sent: Friday, March 30, 2007 2:37 AM 

To: Cindy 

Subject: St. Patrick's cathedral 



Hi Cindy. Can I come with you one day soon to St. 
Patrick's cathedral, where you've been lighting candles? I've 
never been. Maybe one day next week? 

Am I allowed to light a candle for myself, or is that 
considered "self-referral"? © 


From: Laura 

Sent: Saturday, March 31, 2007 1:23 AM 

To: Jennifer 

Subject: More stories from inside 

Hi Jen. Another day, and so many stories. I can't believe 
I was just admitted two days ago — it feels like a lifetime has 
gone by. 

This morning there was a risk management lecture in the 
Department of Medicine Grand Rounds in Hoffman from 8-9 
am. The Departmental secretary had emailed us that we should 
try to go to this one if possible; otherwise the Radiology one is 
in August, which is pretty far away. So I asked permission to go 
to the lecture, which was an elevator ride downstairs from M8. 
The doc covering the lymphoma service said it was OK, so I 
went with face mask, IV pole, and all. It was funny how people 
responded — most people already seemed to know; some looked 
right through me; and some were terrific, as I would have 
expected. I sat with a couple of friends from Radiology. The 
lecture wasn't great. A malpractice lawyer spoke, and she was 
disorganized and didn't say much. But it was good to get off the 
floor for awhile. 



Did you know that when you're an inpatient at Memorial, 
you're entitled to a massage from Integrative Medicine? I had 
Reflexology, which is a massage for your hands and feet. If the 
computer in the room didn't convince me of Divine Intervention, 
the Reflexology did. If it weren't for the chemo, my room 
would be a prime vacation spot! 

David and Nate came to see me yesterday. It was 
David's 50 birthday; he looked exhausted. Nate was in a good 
mood. I think he feels better about applying to college now that 
he's visited a school. Even if he decides not to apply to Cornell, 
our trip there seems to have demystified the process. I had other 
visitors yesterday also, including Cindy, who brought me frozen 

I'm not sleeping much, but I'm getting a lot of writing 
done. Sam agrees that the third intrathecal methotrexate was 
easier than the first two because the oncologist injected it very 
slowly the third time. Apparently, when you inject it too fast, 
once the chemo hits the fourth ventricle it tickles the vomiting 
center in your brain and you puke. I'm going to ask the 
oncologist to inject it more slowly in the future. 

Looks like they're shooting for a possible Monday 
discharge, but it depends on the methotrexate level. As Phil said, 
"It's all about urination now." I have been exceeding 
expectations in the urine output department. They want 150 
cc/hr. I laugh at their 150 cc/hr, and raise it by 50 cc/hr!! 

Thanks for the Bach suggestion. I listened on the iPod 
not only to Yo-Yo Ma playing the Bach Unaccompanied Cello 
Suite in G Major (one of my favorite pieces of all time), but 
also to the other five unaccompanied cello suites, to Hilary 
Hahn playing Bach partitas for solo violin, and to Glenn Gould 
playing the Bach Two- and Three-Part Inventions. You're 
right — Bach has a way of making order and beauty out of 
turbulence and chaos. 




From: Laura 

Sent: Saturday, March 31, 2007 6:07 AM 

To: Jennifer 

Subject: Saturday morning 

Hi J — Saturday morning, almost 6 o'clock. Didn't sleep 
much last night. The chemo part is done; the rest is just the 
leucovorin "chaser" and fluids. That will help lower the 
methotrexate level until it's low enough that it's safe to go 

My hats arrived at the house last week (not a moment 
too soon), but in the hospital I've just been wearing the Monk 
cap that Cindy gave me. I can't believe how Cindy has been 
there for me during my treatment. What a silver lining. 

Charlie, who works in the file room of our outpatient 
breast center, is going to visit me today and bring home-made 
soup. He is a fantastic cook. When I was a resident taking 
weekend call and Charlie worked in the file room at the hospital, 
he used to bring in these savory lunches he had cooked with rice 
and chicken and shrimp and some kind of soup with a tomato 
base and a secret combination of spices. He also used to bring in 
fresh salad with these amazing tomatoes that he grew in his 
garden. All of the residents wanted to work on the weekends 
when Charlie was there. 

Emma gets home from Paris today and will come to see 
me tomorrow. I can't wait to see her and hear about her trip. 

Got to go — they want another urine sample. There's a 
Murphy's law (you know, "whatever can go wrong, will") that 



says the nurses' aide always dumps the urine before they get to 
send it to the lab. I'm swigging the Gatorade now. 


From: Laura 

Sent: Sunday, April 1, 2007 1:44 AM 

To: Jennifer 

Subject: Hair 

Hi Jen. David picked Emma up at the Newark Airport 
last night, and I get to see her later today. 

My hair is falling out. It's so bizarre. You know how 
you brush your hair, and when you get to the bottom it stops? 
Well, now it just keeps going, and all the hair comes out in the 
brush. I know a lot of women who shaved their heads when that 
started happening, but I cling to the hope that a curl or two will 
hang on for dear life. Oh well, hair grows back. David said to 
me, "In September, the cancer will be gone, and so will your 
hair, and I couldn't care less about the hair." 

Nate also helped me feel better about losing my hair. 
One of our family's favorite TV shows is West Wing, the 
Sorkin drama about a fictitious Democratic President named 
Josiah Bartlett and his White House staffers. Early in the 
campaign, Bartlett keeps asking, "What's next?" The staffers 
ask Leo, Bartlett' s close friend and future Chief of Staff, what 
Bartlett means by that. Leo explains that Bartlett is saying that 
he understands the situation, has dealt with it, and is ready to 
move on. Nate reassured me that losing my hair means that the 
chemo is working, and that hair grows back. He added, "It's OK, 



Mom. You can handle it. Do what Bartlett would do. Just ask, 
what's next?" 


From: Laura 

Sent: Sunday, April 1, 2007 7:49 PM 

To: Jennifer 

Subject: Laps and family visits 

Dearest Jen, 

Today was a wonderful day. After I emailed you, I put 
on my shoes and a mask and went strolling multiple laps around 
the nurses' station with my IV pole. The only problem with 
doing laps is that I have to unplug the IV pole from the wall to 
do it, and since the batteries are low the pump starts beeping 
and you have to hit "silence" every couple of minutes. But 
that's a small price to pay for the freedom to roam. 

The bone marrow transplant patients on this floor often 
aren't allowed to leave their rooms. It's such a luxury to be able 
to walk around. M8 was recently redecorated; the hallway walls 
are covered with large nature photos of trees, flowers, different 
seasons, sun, snow, and birds in the sky. The pictures (selected 
by Holly, the floor's wonderful Nurse Manager) make you feel 
like there are windows looking out on a rustic landscape. There 
is also a small room called the family pantry where they have a 
fridge and freezer that patients and their families can use. They 
have coffee, tea, water, and juice there too. This morning I 
"went out for breakfast" — I lapped around the nurses' station 



and went to the family pantry and had some delicious decaf 
with skim milk. 

David and Emma came in the early afternoon. Emma 
was wearing a stunning pair of turquoise shoes that she bought 
on the street in Paris. They were perfect on her — they even 
showed toe cleavage (this is the latest thing — what a term!). She 
bought me a necklace with an antique chain and stones in muted 
colors as well as a little card from Paris with a hand-painted 
picture of a Parisian cafe. I have a bulletin board with tacks in 
my room, and she wrote "Emma" in the tacks on the bulletin 
board. David and Emma stayed about an hour and a half, and 
Emma told us all about her trip. After they left, I liked looking 
at the bulletin board, and seeing the "Emma" design — it made 
me feel like she was still there. 

Nate came later. We had a quiet visit. Sometimes we 
didn't talk; I just read the paper while he was surfing the net on 
the computer. We walked 7 laps around the nurses' station 
together before he went home. 

The Op Ed page of the Sunday Times featured a piece 
by Dr. Harold Varmus, the Nobel prize-winning scientist who is 
the President of Memorial, in which he said that we are winning 
the war against cancer. I always wanted to win the war on 
cancer, but for some reason I'm particularly passionate about it 




From: Laura 

Sent: Monday, April 2, 2007 12:10 AM 

To: Nate 

Subject: Fro yo 

Hi Nate. Thank you for coming to visit me, and bringing 
the frozen yogurt ("fro yo")! I just took my midnight 
"constitutional" and got some fro yo in the family pantry — I 
finished the one that was almost empty and got a good healthy 
start on the one you brought. Thanks for providing my midnight 
snack. Now I'm listening to Stevie Wonder singing "Ribbon in 
the Sky," another beautiful song. I only did another one lap 
instead of seven more this evening, but it was good. 

Love to Dad and Emma. 


From: Laura 

Sent: Monday, April 2, 2007 1:36 AM 

To: Frances 

Subject: Prayer group 

Hi Frances. Please thank your prayer group for the 
beautiful prayer they sent me, called "I Asked God." 



I asked God to take away my pain. God said, No. 

It is not for me to take away, but for you to give it up. 

I asked God to make my handicapped child whole. God said, No. 

His spirit is whole, his body is only temporary. 

I asked God to grant me patience. God said, No. 

Patience is a byproduct of tribulations; it isn't granted, it is learned. 

I asked God to give me happiness. God said, No. 

I give you blessings. Happiness is up to you. 

I asked God to spare me pain. God said, No. 

Suffering draws you apart from worldly cares and brings you 

closer to Me. 
I asked God to make my spirit grow. God said, No. 
You must grow on your own, but I will prune you to make you 

I asked God for all things that I might enjoy life. God said, No. 
I gave you life, so that you may enjoy all things. 
I asked God to help me love others, as much as He loves me. 
God said Ahhhh, finally you have the idea. 


From: Laura 

Sent: Monday, April 2, 2007 7:21 AM 

To: David 

Subject: Coming home 

Hi Babe. Just a note to thank you for bringing your 
button-down green flannel shirt for me to wear this morning. It 
makes me feel protected by you. It's much easier to maneuver a 
button-down shirt than a pullover shirt when I'm hooked up to 
an IV — to get out of the pullover, I actually have to push it 



down to the floor and step out of it, and step into the next shirt 
and pull it up. And there's another advantage to the button- 
down — it has a pocket for me to put the iPod in! I walked 
multiple laps around the nurses' station this morning and then 
"went out for coffee" to the Family Pantry. Apparently 14 laps 
is a mile (a patient on 12 clocked it), so I can even quantify my 
exercise — I walked more than a mile today! 

I slept well last night and took a good shower this 
morning. They're still giving me the leukovorin "rescue." It's 
my favorite part of the chemo. I'd much rather have someone 
give me a "rescue" than a "CHOP." They really have to rethink 
the names of these chemo regimens — "CHOP" is bad enough, 
but apparently there's another one called "ICE." What kind of 
message does that send? Anyway, I just called the cafeteria 
(euphemistically referred to as "room service") to order 
breakfast, and they picked up the phone right away. Scrambled 
eggs and toast and decaf and a fresh orange and a banana. 

They run the methotrexate level at noon, so it probably 
won't be back until 2. Do you want me to call you when they 
are actually discharging me? It'll probably be sometime 
between 2 and 5 pm. I really want to go home today, so before 
they take my temperature, I will suck on ice chips to make sure 
there is no fever (only kidding — although it's tempting). 

I got an email from a former Croatian breast imaging 
trainee. He told me to "beat that crazy lymphocyte!" 

I love you. 



Chapter 7 

Cancer is the best excuse you 7/ ever have — use it! 

From: Laura 

Sent: Monday, April 2, 2007 10:00 PM 

To: Jennifer 

Subject: Home 

Hi J. I am home, and it is even more wonderful than I 
remembered. Just to be free from the IV pole is bliss. 

Hope your Seder was fun. Did you drink in the reclining 
position? Who asked the 4 questions? Sophie's probably too 
young, or maybe her questions were, "When do we eat? Can we 
eat now? When can we play? When do we go home?" 

Happy Passover. 


From: Laura 

Sent: Tuesday, April 3, 2007 10:56 PM 

To: Jennifer 

Subject: Shopping with Emma 

Dearest Jen, 

Emma and I went on a shopping spree today after work 
to get spring clothes. I wore one of my Christine Moore hats for 



the first time. I chose the Easy, which has a beige straw cloth 
slouch crown with a medium up brim, a little bow, and thin trim 
in a pattern of tiny vertical stripes in turquoise, pink, yellow, 
and white. 

First, we went to a shoe store called Arche. They had 
just gotten in their spring sandals, and they had a style that fit 
me perfectly: it was as if they had custom designed these shoes 
for my feet! I bought them in four colors (turquoise, yellow, 
pink, and tan). We went to Eileen Fisher, and I bought some 
clothes to wear when I'm in the hospital. Then we went to Olive 
& Bette's to get summer camp clothes for Emma. David thinks 
I was having a manic episode, and maybe I was, but losing your 
hair is tough — I had no idea my head was so white — and the 
stuff I got will help me feel beautiful, or at least I'll feel like my 
shoes and clothes are beautiful. 

Tomorrow I'm going to work in the Women's Office. 
Thursday I have to get a blood test, and then I'm going back to 
the wig place. Now I wish I'd just gotten a wig with short hair. 
Life is too short to waste time with stuff that doesn't matter. 


From: Laura 

Sent: Thursday, April 5, 2007 5:22 AM 

To: Cindy 

Subject: Re: checking on you 

Hi Cindy! I missed you yesterday too! 
I came to work and got great stuff done in the Women's 
Office. Did I tell you I'd like to create a Women's Oncology 



Network (abbreviated WON) that is an international society of 
women doctors and scientists dedicated to eradicating cancer? 
So yesterday, I decided on the T-shirt slogan, and on the society 
stone and color. 

Here's an excerpt from the grant proposal. 

The goal of WON is to provide mentorship, 
collaboration, and unity among women physicians and scientists 
dedicated to the clinical treatment and research investigation of 
cancer. Our T-shirt slogan will be: "WON for all and all for 

The color/stone of WON will be turquoise, long 
considered a stone that is holy, brings good fortune, and fends 
off the evil eye. Al Qazwini, the Persian scholar, wrote: "The 
hand that wears a turquoise and seals with it will never know 
poverty." The Aztecs in Mexico believed that the sky blue 
gemstone directly connects the sky and the sea. In Orthodox 
Judaism, turquoise is the only non-white thread in the prayer 
shawl, representing the uniqueness of individuals. Turquoise 
has been deemed to provide protection from darkness, to guard 
horses and riders from unexpected falls, to endow shy people 
with confidence, and to be responsible for faithfulness and 
constancy in relationships. Turquoise is the perfect stone for 

Between you and me, the real reason I picked turquoise 
is because I love that color and it goes with my eyes. I'm also 
tired of pink for girls and blue for boys. This way we get our 
own blue, and a beautiful blue it is! I stopped by to see you in 
Mammo but it was after 5 pm and I must have just missed you. 



I wanted to show you my new hat, called the Natasha. It's a soft 
weave with a medium brim, silk binding, and a beautiful silk 
bow, all in a deep violet. 


From: Laura 

Sent: Sunday, April 8, 2007 8:56 PM 

To: Jennifer 

Subject: Quiet Sunday 

Dearest Jen, 

Today was quiet. I went out for a walk in the sun, but 
came home after a block and a freezing gust of wind. A good 
day to stay home and be warm. Emma and I watched the DVD 
of Season 1 of Project Runway (one of our favorite shows). 
Now I'm going to bed. 




From: Laura 

Sent: Monday, April 9, 2007 9:57 PM 

To: Jennifer 

Subject: Playing the cancer card 

Dearest Jen, 

My friend Maureen taught me that cancer is the best 
excuse you'll ever have, so use it — she calls it "playing the 
cancer card." So far I've only done it once, to get the dinner 
reservations for David's birthday party. But today I found the 
perfect opportunity to do it again. 

In our building, people generally get cabs on a first- 
come, first-served basis. But you know how some people 
believe that the social contract doesn't apply to them? Well, 
there is one Evil Woman in the building who always jumps the 
line. It's so annoying — no matter how long you've been waiting, 
she cuts ahead and barrels into the cab. 

Today, I was waiting for a cab when finally it pulled up 
into the driveway. Suddenly, the Evil Woman appeared and 
started to cut ahead of me in line. I said to her calmly, "Excuse 
me, but I have cancer, I need to get chemo, and that's my cab." 
She stopped in her tracks and stared at me, open-mouthed. 
While she gaped, I jumped in the cab and drove away. Success! 
I wish I had thought of doing this a decade ago. And the best 
part of all — I wasn't even going to chemo, I was going 
shopping at Bloomingdale's! 




From: Laura 

Sent: Tuesday, April 10, 2007 6:19 AM 

To: Jimmie 

Subject: Statistics, and update 

Hi Jimmie. Thanks for the wonderful talk — it's great to 
be able to discuss how it feels to be a doctor and a cancer 
patient with the former Chair of Psychiatry at Memorial, who 
practically invented the field of Psycho-Oncology. 

I'd love to read the Steven Gould essay you suggested 
about statistics in cancer. Now is a perfect time for me to read it, 
because the statistics are against me. I'd also love to read your 
book on The Human Side of Cancer. You can send them to me 
either at the hospital or my home address. 

Re update — I'm doing great. I've finished one month out 
of 6 months of chemo, and I'm a little euphoric about it. I have 
bought 15 beautiful new hats (I am looking at this not as losing 
my hair, but as an opportunity to buy new hats), and people are 
starting to give me hats as presents. I knew that the hats would 
be a fun distraction for me and would help me feel better during 
treatment. What I didn't anticipate is another huge benefit: hats 
are terrific icebreakers. You know how some people just don't 
know what to say when you have cancer? Well, when 
somebody can't think of anything to say, I can always ask, "Do 
/ou like my hat?" and, relieved, they comment on my hat. 

I'm writing a book. I'll send it to you when it's done. 




From: Laura 

Sent: Tuesday, April 10, 2007 5:30 PM 

To: Jennifer 

Subject: Chemo OK today! 

Hi Jen. Thanks for the beautiful baseball cap that says 
"Chemo means never having to have a bad hair day!" 

I went for outpatient chemo today. I got to the hospital 
around 9 am. After my blood test came back, I had to wait two 
hours for them to mix the R-CHOP so I went to a colleague's 
office and worked on the computer for awhile. Around 1 1 :30, 
they started the chemo. Some of the premedications made me 
sleepy. My nurse was named Marina, from the Ukraine. I got 
the chemo, napped an hour, and was done by 3:00. It was much 
quicker than last time — they go slow for the first R-CHOP to 
make sure you're not going to have a reaction, and since I 
passed that test, they could go much faster. Tentatively, they 
plan to admit me to the hospital for another inpatient chemo in 
two weeks. 

I'm sorry you've reached the "no sleep" stage of 
advanced pregnancy. Do you have funky pillows in many 
shapes? That seemed to help me. Although being able to breathe 
probably would also be a big plus. Don't worry, these days will 
pass, and soon you'll get to meet your wonderful son, and I hope 
he brings you all the joy that Emma and Nate bring to me. 




From: Laura 

Sent: Tuesday, April 10, 2007 8:47 PM 

To: Jennifer 

Subject: Ode to a Neutrophil 

Hi Jen. I know I just wrote to you, but there's one more 
thing I forgot to tell you. I've been going through piles of old 
papers at home, throwing away massive amounts of stuff. It's 
always been hard for me to throw things away, but somehow, 
having cancer makes it clear to me that there are some things 
that will never be high enough on my radar screen for me to 
devote time to them, so I've felt freer to jettison old crap. 

While sifting through ancient papers, I found a poem 
that I wrote during my first year of medical school at Columbia 
College of Physicians & Surgeons (P&S) about the neutrophil, a 
white blood cell (also called a polymorphonuclear leukocyte or 
"poly") that fights infection. This topic is particularly dear to 
me now because chemo lowers my white blood cell count, 
making me susceptible to infection. The poem describes how 
the precursor cell, the myeloblast, grows up into a neutrophil, 
and then experiences the life and death of a hero combating 
infection in his host. Here it is: 

Ode to a Neutrophil by Laura Liberman 

Now once there was a myeloblast in bone marrow awaiting 
The day when he would grow up and start differentiating. 
His mother, a promyelocyte, urged him with voice emphatic, 
"Develop! Get some lysosomes! Be metachromatic!" 



He was about to do it when a red blood cell nearby 
Said, "You'll regret it if you do it, pal." "Regret it? Why?" 
The red blood cell explained to him, "If you become a poly 
You'll live 2 days in tissues and then die. It would be folly 

For one so young, such as yourself, to throw your life away 
And live 2 days when you could live 4 months another way. 
"Could live 4 months? How could it be? You mean there's 

hope in sight?" 
The myeloblast demanded of the young erythrocyte. 

"Of course," replied the RBC, for you know very well 

You live 120 days if you're a red blood cell." 

So saying, the erythrocyte got up and swam away. 

The myeloblast thought over what his friend had had to say, 

And he resolved to try it. Yes, he would run any risk 
In order to transform into a red biconcave disc. 
And so, instead of synthesizing many lysosomes 
He tried to make just hemoglobin off his polysomes 

So he could carry oxygen just like a red blood cell. 

The myeloblast then tried to lose his nucleus as well. 

His mom, a metamyelocyte, about to be a band, 

Said, "What's holding you up, my son? I do not understand. 

You should have had those granules inside you long before. 
Now, hurry! There's no time to spare! You can't wait 

"But, Mom," replied the myeloblast, "I can't do what you do 
'Cause if I do that I'll become a neutrophil like you, 



And die after two days of life. But red blood cells live on 
So to erythropoietin I must learn to respond!" 
His mother, then a neutrophil, said, "Son, give up this game. 
The situation's desperate 'cause the tissues are inflamed. 

I know there's an infection. I feel it in my lobes. 

I know that those bacteria are entering in droves. 

And only we can stop them, son. It's true our life has flaws 

I know that we must die for it, but we die for a cause." 

She turned and left the bone marrow, swam through the 

And gave a last long look at her delinquent little boy. 
He thought it over. No, he couldn't selfishly ignore 
His duty as a neutrophil as he had done before. 

"Longevity is nice," said he, "but I must do what's right, 
And so I'll be a polymorphonuclear leukocyte." 
And so, our friend the myeloblast gave up his former ways. 
He turned into a neutrophil in less than 14 days. 

And then he left the bone marrow, swam through the 

Diapedesing when he found the site of inflammation. 
"The place is full of bugs!" he cried. "Now what am I to 

A nearby poly said, "Just eat it, get it inside you, 

And let your granules do the rest." Our friend then heard 

the moanin' 
Of an unlucky bug who had been coated with opsonin. 
He hit it with his 2-1 punch until it was digested 
Then turned to other bugs with which the tissue was infested. 



It was a hard-fought battle, but the polys won the war. 
The tissue, once inflamed, became just as it was before. 
But yea, alas, our poly was breathing his last breath. 
His two-day life was over. He died a martyr's death. 

So let us thank the neutrophil, who gives his life to us 
Who fights with our bacteria and dies with them in pus. 
No choristers will sing for him. For him will toll no bells, 
But we will thank the neutrophil, the noblest of the cells. 

As I recall, when I recited the poem to Dr. John 
Lindenbaum's hematology class at Columbia P&S, there wasn't 
a dry eye in the house. 



Chapter 8 
Reaching Out 

Ask for what you need. Use your experience to help others. 

From: Laura 

Sent: Tuesday, April 10, 2007 6:20 PM 

To: Mel 

Subject: Heads up, and Jung-min 

Hi Mel. I am writing for three reasons. First, I want to 
tell you how wonderful it was to see you at the National 
Institutes of Health breast cancer meeting on ductal carcinoma 
in situ (DCIS) in January. I loved your presentation of the data 
on DCIS from your surgical practice. You don't look a day older 
than you did when we met in Venezuela 15 years ago. It was 
like old times. 

The second reason is that I want to give you a heads up 
on some stuff going on with me. I was recently diagnosed with 
an aggressive marginal B zone lymphoma and started six 
months of chemotherapy in March. So far, I've received 7 of 18 
doses of chemo: 2 of 6 outpatient IV R-CHOPS, 4 of 6 
outpatient intrathecal methotrexates, and 1 of 6 high-dose IV 
methotrexates. If all goes well, I'll be done in September. 

But the most important reason I'm writing is reason #3. 1 
have the most fabulous fellow on the planet named Jung-min 
who has been doing research with me for two years. She has 
applied for the Oncology Fellowship at your hospital to begin 
July 2008. Since joining me, she has presented an abstract at a 
national meeting, written a first-author paper in press, and 
started a second manuscript. In addition, while I've been getting 



chemo, she has kept up my huge database on image-guided 
breast biopsy. Jung-min has allowed me to maintain an active 
research program when it would have otherwise been 
impossible. I don't know anyone else who could have stepped 
to the plate the way she did. 

Jung-min will be coming out to interview at your 
hospital soon (I'll send you the exact dates). I'd love for you to 
speak with her. I know you're not involved with admissions to 
the Oncology program, but it would be great if she could sit 
down and talk to you about the pros and cons of the different 
programs in your area that she's considering, to help her decide 
what would be best for her. 

She can be shy at first, but I know she'll be comfortable 
with you. Don't let her quiet demeanor dissuade you. Jung-min 
is among the most outstanding trainees I've ever had in almost 
two decades as well as a caring and sensitive person, and I've 
worked with some pretty awesome people. 


From: Laura 

Sent: Wednesday, April 11, 2007 8:28 AM 

To: Mel 

Subject: Kindred spirits 

Dear Mel, 

Thanks for your beautiful letter. I see that we are 
kindred spirits. 

I didn't know about your health problems — I am so 
sorry that you had to go through that! I am inspired by your 



survival, but it doesn't surprise me about you. If you can make it 
through an aortic dissection, maybe I can handle a pinch of 

I am writing a book about the experience of being a 
doctor and a patient. I'm thinking of calling it "Both Sides Now" 
(like the Joni Mitchell song). 

I still look for justice in the universe, in spite of all 
evidence to the contrary. For some things I can't find the justice. 
Maybe that's where faith comes in. I didn't think I had much of 
that, but I'm finding more comfort in the prayer stuff than I 
would have believed possible. 

I will send you updates. Thank you for agreeing to meet 
with Jung-min. I love her like a daughter. 


From: Laura 

Sent: Wednesday, April 11, 2007 8.45 PM 

To: Mel 

Subject: Backstory: David 

Dear Mel, 

I got an email back from the fellowship program director 
at your hospital. It looks like she is one of the good guys! I told 
Jung-min that she should look for you when she visits, and that 
you would look out for her. You will love her too. 

You are right when you talk about how we meet at 
meetings and know so little about each other. Let me tell 
you more. 



I met my husband, David, the summer before my 
freshman year in college. I was 16 (I had skipped a couple of 
years in school) and David was 19. He was my lab partner in 
Physics at Harvard Summer School. I was sitting in class on the 
first day in a pair of very short shorts (it was the seventies). 
David walked in: long black hair, moustache and beard, old 
beat-up sneakers, blue t- shirt, cozy flannel overshirt, and faded 
jeans, with a Dos Passos novel in his back pocket. He had a 
choice of sitting next to me or a woman with very large breasts 
named Liane who went to Wellesley. Luckily he picked me. I 
was especially lucky because I had originally signed up to study 
mime and juggling in Paris, Maine that summer, and switched 
to Physics at the last minute. Otherwise, I might have married a 

After class, we went out for coffee together at a little 
cafe in the Harvard Science Center. He told me his name was 
David. I told him my name was Laura and that I had a brother 
named David (his age) and he said he had a sister named Laura 
(my age, living in Hollywood). When he revealed that his 
grandmother had a parakeet with the same name as my parakeet 
(Blue Boy), I knew that we were meant to be together. I found 
out quickly that he was a jazz enthusiast and was missing it 
terribly in Boston. He had brought two jazz mixed tapes and a 
small tape player, and listened to those tapes constantly. We 
shared a love of music; I'd previously listened primarily to 
classical music, but he introduced me to jazz. 

A couple of nights after we met, I had to go get 
groceries in Harvard Square. David needed some stuff and 
asked me to pick it up and gave me his key to drop the stuff off 
in his room. I made a copy of his key. I didn't realize that this 
was a big deal, something that got discussed — I was just being 
practical. I figured I'm going to be spending time with this guy, 
so I need a key. I also got him one of those Hallmark cards that 



said, "Love is where you find it. . . I'll be here all day." And I 
wrote in: ". . .and for the rest of your life." Why he didn't run 
screaming in the other direction I can't imagine. 

We were long distance for four years in college — he 
went to Dartmouth and I went to Harvard — and we had a 
commuter bus ticket from Boston to White River Junction, 
Vermont. He was a year ahead of me in school, so he graduated 
first. He went to medical school in New York, and I followed 
him to New York when I graduated college. We lived together 
for two years in medical school and then got married. I had 
basically asked him to marry me the summer we met; a mere six 
years later, he said yes. (But the company line is, he got down 
on bended knee and begged me to be his wife. That's our story 
and we're sticking to it.) 

David and I have known each other 3 1 years out of the 
47 I've been alive, and we celebrate our 25* wedding 
anniversary this June. He's a doctor specializing in Infectious 
Disease at Beth Israel in downtown New York, and does a lot of 
clinical work and research with AIDS patients. David is the 
most amazing husband and father. We go to jazz clubs together, 
and read books and hang out with the kids. He is my bird — we 
mated for life. 

If I had to have cancer, I couldn't have picked a better 
partner to help me through it. Sometimes I think it's harder on 
the spouse than it is on the cancer patient. My mission is 
focused and defined (survival), while David has to pick up the 
pieces, emotionally support me and the kids, and deal with all 
the logistics of daily life. I tell the women faculty that one of the 
most important decisions they make is about a life partner. Life 
throws you a lot of curve balls, and if you're going to choose a 
partner, it should be someone who'll actually help. 
Unfortunately, by the time they're women faculty they've often 
made the choice already, and that ship has sailed. Sometimes I 



think the best thing we could do in the Women's Office is to 
find a bunch of suitable Significant Others for our women 
faculty, but I bet that's way beyond our budget. 


From: Laura 

Sent: Thursday, April 12, 2007 8:47 PM 

To: Mel 

Subject: Backstory: Dad 

Dear Mel, 

Thanks for your email. I loved the story of how your 
parents met when your father was pumping gas in a gas station 
and your mother was in the car with her step-mother. I'm sorry 
that they each lost a parent at a young age. It's interesting that 
the lesson they taught you as a child was that everything you 
have could quickly be taken away from you. You asked about 
my parents, so I'll tell you. 

My father, Robert Liberman, grew up in Chicago in the 
Depression. His dad died when he was six years old. He and his 
mom lived with relatives who argued all the time. My father 
was a peace-loving man who would walk 20 miles to avoid an 
argument. Being dependent on cantankerous relatives taught 
him the importance of being able to make your own living. "Be 
financially independent" was the take-home message of my 
childhood. My dad was a gifted pianist and had studied with 
Vladimir Horowitz's teacher. He could have been a concert 
pianist, but he hated to travel. More importantly, having grown 
up poor, he wanted a steady income. 



The year my father graduated from high school, 
Sears/Roebuck gave a full tuition scholarship to the student who 
graduated first in his class from John Marshall High School, 
where my dad went. That person was my father. Being #2 
would not have been good enough. That's how I learned to go 
for the top. He went to the University of Chicago (his home 
town) courtesy of Sears, joined the Army in World War II, and 
then attended Law School courtesy of the Army. When I went 
to college, it was a great source of pride to him that he could 
help pay for my education. 

My dad was a law professor at Boston University. Law 
was an interesting career choice for a man who hated an 
argument. He practiced law only briefly. He mainly taught, and 
he was a wonderful teacher. He never pretended to know 
something he didn't — instead, he asked someone who knew, 
looked it up, or figured it out himself. I learned that lesson from 
him, and it's crucial, especially in medicine, where it can be 
life-threatening to pretend you know something you don't. 

He used to take me out on Sunday mornings to breakfast 
at a Jewish deli in Boston called the B&D, and he taught me 
how to do algebra problems on the back of a paper napkin. John 
is two years older than Mary. In one year, John will be twice as 
old as Mary is now. How old are John and Mary? And I was 
always amazed that my father knew so many Johns and so many 

My father met my mother on a blind date when she was 
in law school and he was a practicing lawyer. A friend asked 
him if he wanted to meet a cute blonde or a big Israeli. He chose 
the big Israeli, Judith (now Judith Weinshall Liberman) — that's 
my mom. She's tall, about 5'10"; he was 5'7". She got the best 
grades in the class and worked the hardest. In a Master of Laws 
program they took after they got married, my mom studied like 
crazy; my dad just skimmed her notes the night before the exam. 



She got the highest score and he got the next highest — a hair 
lower, but with much less work. She laughs when she tells the 
story. I was a student in my mom's tradition of relentless 
workaholism, while my husband was a more inspired and laid 
back student like my dad. My mom gave up law to be an artist, 
while my dad became a law professor. 

Having pulled himself up from poverty, my father knew 
the value of hard work. He used to quote Thomas Edison, who 
said, "Genius is 1% inspiration and 99% perspiration." We used 
to play the card game, "Hearts." Usually, in Hearts, every heart 
you win counts one point against you, and the Queen of Spades 
counts 1 3 points against you. However, winning all of the hearts 
and the Queen of Spades is a landslide victory called "shooting 
the moon." My dad always tried to shoot the moon, and usually 
succeeded. He taught me to try even when the outcome was 
uncertain. Again, he quoted Edison: when Edison's initial 
attempts to invent the light bulb did not yield the results he 
hoped, he said, "I have not failed. I've just found 10,000 ways 
that don't work." 

When I was in high school, Stanford was my top choice 
for college. I looked at the map of the country and saw that Palo 
Alto, California was about as far as you could go in the United 
States from Newton, Massachusetts, and figured that's what I 
had to do to be independent. Luckily I was rejected. Maybe they 
thought I was too young at 16. But I picked up the broken 
pieces of my life and went to Harvard. Proximity to my family 
turned out to be a wonderful thing. My father had a heart attack 
the summer after my freshman year in college and then multiple 
strokes after that, and spent much of the next few years in and 
out of the hospital. Because I was in school so close to home, I 
was able to spend precious time with him. 

While I was growing up, my father loved to play the 
piano. I remember falling asleep at night listening to him 



playing Chopin Nocturnes (how many girls are lucky enough to 
get that kind of lullaby?). Encouraged by my father, I started 
playing the piano when I was six. When I was ten and again 
when I was twelve, I was the guest piano soloist with the 
Boston Symphony Orchestra. We had two pianos at home, a 
small upright and a big grand piano, both in our living room. 
We played piano duets together, for fun and in concerts. My 
favorite was the Schubert Fantastia in F Minor, where the 
voices of the two pianos echo and complement each other like 
two inseparable friends. 

My father loved to read and analyze literature. He was a 
terrific writer and published short stories. A gentle soul, he 
wrote surprisingly dark stories, some of which reflected 
memories of German concentration camps that he had seen in 
World War II. He loved to read books about the process of 
writing, like The Technique of the Novel by Thomas Uzzell. I 
got my love of reading and writing from him, and have passed it 
on to Nate and Emma. He would have loved to write a novel, 
but he got stuck in the outline phase. Years of outlines, covering 
one yellow legal pad after another with his exuberant 
handwriting in black ink. 

I remember speaking to him one night right after he had 
the stroke that robbed him of his ability to play the piano. I have 
never heard a voice so broken by loss. He told me that he was 
sorry I had been born, because he did not want me to get hurt 
someday as he had been hurt. He said, "Why couldn't I have 
brought someone into the world who is heartless, cruel, cold, 
and unfeeling? The world is no place for sensitive people." 

When he was in the hospital, he had slurred speech from 
the stroke, but his mind was lucid. I remember how some of the 
doctors and nurses treated him like he was stupid because he 
couldn't enunciate his words clearly. I couldn't believe what a 
difference it made to his outlook and self-esteem whether he 



was treated with respect and compassion or with the assumption 
that he was an idiot. 

My father had always wanted me to be a doctor. When I 
was six years old and playing the piano, people would ask my 
father, "What does Laura want to be?" And he said, "She wants 
to be a concert pianist, but medicine will be her back-up 
profession." I remember thinking, "I never said that. That must 
be what he wants." When my father got sick during my college 
years, I gave up my physics major (which I had particularly 
enjoyed because I was the only girl in the class) and decided to 
be a doctor. I figured that's what he wanted, and I loved him so 
much that I wanted it too. Maybe I could keep people from 
suffering the way he suffered. 

My father taught me what it takes to master something. 
He used to practice the piano for hours daily. He used to say, "If 
I don't practice one day, I know it; if I don't practice two days, 
my friends know it; if I don't practice three days, the audience 
knows it." After the first stroke, he was tireless at doing his 
rehabilitation exercises. He spent hours relearning activities like 
putting on socks, tying his shoes, and walking. He never got 
impatient or frustrated; if he didn't succeed, he would simply do 
it again. Once I went to rehab with him, and I remember how he 
asked the therapist to give him more exercises. "I'm very good 
at practicing," he told her. He was right. 

My father died right after I began my radiology 
residency in New York. He had spent much of the last few years 
of his life terrified of becoming a vegetable from another stroke. 
As it turned out, he worried for nothing — he died of a massive 
heart attack in the middle of a chess game, and he was a knight 
and a pawn ahead at the time. If my father had only known that 
would be his exit strategy, the last few years of his life would 
have been so much better! He would have particularly enjoyed 



that at the moment of his death during the chess game, he was 

He wanted to be cremated and have his ashes scattered 
in the ocean. On the morning of his funeral, I couldn't believe 
that the sun was shining as if nothing had happened. We rented 
a boat in Maine, and released his ashes with Beethoven's 7 th 
Symphony, 2 nd movement (Allegro) playing. I chose that music 
because it combines major and minor keys, expressing how life 
is full of both sorrow and joy: it's sad that he died, but it's even 
more glorious that he lived. The score starts with a simple base 
line, and then progressively adds more and more instruments 
until there is a groundswell of unbelievably beautiful music, 
analogous to starting at birth, finding more complexity and joy 
at each level of life, and finally earning the ascent into heaven. 

During the funeral, I was comforted by the fact that my 
father had met and liked David, and that he got to attend our 
wedding three years before he died. However, I was seized by 
the thought that now my kids (who were not even a twinkle in 
my eye at that point!) would never get to meet my father. It was 
an odd thought. Until then I hadn't been certain about having 
children, but when I lost my father, I realized that having kids 
was no longer a question of whether, only when. I wish I could 
talk to my father again, even just for five minutes, and I wish he 
could meet Nate and Emma. Talk about a sense of humor. He 
had it all. 

That's my story. Maybe that's how I'll tell it in the book. 
The book may end up being emails that I write and receive 
during this journey. If it's OK with you, I may include the 
picture you sent me of the seed becoming a plant that grew right 
through the roof of your hot tub. That was a beautiful picture 
and a beautiful story. I hope to be strong like the seed, and to 
break through hot tub covers in a single bound. 




From: Laura 

Sent: Friday, April 13, 2007 5:36 AM 

To: Mark 

Subject: Pain: ideas 

Hi Mark. I want to touch base with you in your capacity 
as a neurosurgeon about something important. I've had four 
Omaya taps for intrathecal chemo so far, so I speak from some 
experience. My lymphoma doc is a wonderful doctor and a 
terrific human being. The procedure itself, however, is painful. 

Sometimes, as doctors, we feel that the most important 
aspect of treatment is killing the cancer, and if that means you 
feel a little pain, you should "suck it up." I agree that if killing 
the cancer requires pain, suck it up. But if the cancer can be 
cured in a way that is painful or less painful but equally 
effective, the less painful method is the clear choice. 

There is a feeling (of which I have also been guilty, 
when I got to play doctor) that focusing on the pain distracts 
from the major mission of curing the cancer. That's wrong. 
Even if the physician who has primary responsibility for killing 
the cancer doesn't want to be "distracted" by thinking about pain, 
we should make it a priority that someone on the team is 
focused on pain relief. We should not tolerate errors in pain 
management any more than we would tolerate giving the wrong 
dose of chemo, or treating with an improper antibiotic, or 
performing surgery on the wrong side of the body. 

I have specific suggestions for pain prevention when 
putting a needle into an Omaya. For the past few decades in 



Breast Imaging, we've been doing pre-operative needle 
localization procedures, in which we place a wire in a woman's 
breast pre-operatively to guide the surgeon towards a breast 
lesion that can't be felt. Before the loc, we spray the area of the 
breast with a spray called "Gebauer's Ethyl Chloride Medium 
Stream Spray," which is considered a "topical anesthetic skin 
refrigerant" and works instantly. Another good local anesthetic 
is Emla cream. It can be applied over the area to be accessed (eg 
the Omaya or Mediport), but unlike the spray, the Emla cream 
requires half an hour to work. 

Since you put the Omayas in during neurosurgery, is 
there a way you can convey in the post-op instructions 
the recommendation for numbing prior to putting a needle into 
the Omaya to remove fluid or give chemo? You can even 
suggest the Ethyl Chloride spray and the Emla cream. Either the 
treating oncologist could give the patient the necessary 
prescriptions, or we can make sure that the meds are available 
in all the chemo suites so that they can be used to increase 
patient comfort for all needling procedures. The spray or Emla 
cream could also be used prior to other needling procedures 
elsewhere in the body, like accessing Mediports. After the 
anesthesia, the area can be prepped with sterile technique, so it 
shouldn't increase the chance of infection. 

Another thing. I learned through personal experience 
that the likelihood of vomiting is directly related to the speed of 
intrathecal injection. Sam, my neurologist, confirmed that if it's 
injected too quickly, once it hits the 4th ventricle it tickles the 
vomiting center and you puke. If we're rewriting the post- 
Omaya instructions, can we include the recommendation to 
inject slowly, and maybe even give a guideline as to the 
maximum suggested injection rate? Most intrathecal chemo 
patients probably believe that vomiting just goes with the 



territory, and would not think to ask the physician to slow down. 
We need to write it into the guidelines to make it happen. 

I'd appreciate your thoughts. I am no wimp and if pain 
is necessary to cure my lymphoma, I'll endure it. But if we can 
make it less painful or even painless, we should go for it. Even a 
small amount of pain per procedure over a long course of 
treatment adds up, and gives those individuals with cancer yet 
another thing to dread. It is our mission not only to cure cancer 
but also to relieve suffering. We can be the best at both. Let's do 
it. Then I will know that my lymphoma is for a good reason, 
and I will find the justice in the universe that I perpetually seek. 

Best wishes 

And in a spirit of making things better (always) 



Chapter 9 
Blurry Vision 

Get your priorities straight. 

From: Laura 

Sent: Friday, April 13, 2007 8:26 PM 

To: Sam 

Subject: Blurry vision: questions 

Hi Sam. Question for you about my eyes — I have 
worsening blurry vision the last few days, which makes it 
difficult to read (but doesn't stop me from sending an email!). 

I've been near-sighted requiring glasses since I was six 
years old. I started to have trouble reading several months ago, 
and now have "progressives," which I gather are the new 
"bifocals." When I began having the neuro symptoms that led to 
the eventual diagnosis of lymphoma, I saw Jack of 
Ophthalmology here, who saw a few cells in my eyes that were 
suspicious for lymphoma (apparently that's reasonably frequent 
if you have lymphoma in the CSF). . 

Now I've finished four intrathecal methotrexates, two IV 
R-CHOPS, and one high-dose IV methotrexate, with the most 
recent intrathecal methotrexate and IV R-CHOP being this past 
Tuesday 4/10 (which I tolerated fine). In the past several days 
I've noticed a worsening of blurry vision, which makes it 
difficult to read. Could this be related to the steroids (I'm on day 
three of five days of oral prednisone through Sunday 4/15)? If it 
is due to the prednisone, is the blurry vision likely to get better 
when I'm off prednisone? I'm especially concerned because my 
eyes are key in radiology, especially breast imaging — you have 



to be sharp if you're going to pick up the tiny 
microcalcifications that may be the only sign of an early breast 
cancer. Alternatively, could the visual blurring be due to 
worsening lymphoma of the eyes, especially in light of the 
abnormal cells in my eyes before I began treatment? 

Should I have labs checked (and if so, which labs and 
when, and can you put in and release the orders)? My next 
scheduled appointment with my oncologist is on Thursday 4/19 
at noon, when I am scheduled to get more intrathecal chemo. 
Should I make another appointment with Jack, see my outside 
eye doctor to get my prescription checked, or just wait until 
Thursday and see my oncologist then? Thanks for your advice! 


From: Laura 

Sent: Saturday, April 14, 2007 4:32 AM 

To: Jennifer 

Subject: Saturday 

Hi Jen. We had a great day yesterday. In the morning, 
David rented a car to take Emma and me to a parent-teacher 
conference at Emma's school. I wore a hat called the Gordon, a 
straw fedora in a muted pink with flip brim and silk gray trim. 

I was so proud of Emma at the conference. Going from 
elementary school to high school is a big transition, even 
without having a sick mom, and she's been handling it 
beautifully. Emma came to the conference with us, and became 
a little shy when her advisor read all the fabulous comments 
from her teachers. Afterwards, Emma went to class. David 
dropped me off at the hospital and went to work. 



The main event on my calendar at work today was a 
meeting about "the MSK Nanny Resource," an internal list- 
serve we're creating to address the issue of child care for 
employees. We brainstormed this idea with Amy and Nancy, 
my colleagues in Work/Life, after we collaborated on a seminar 
called "How to Find a Nanny." On the Nanny Resource, 
employees can post if they want to hire or share a nanny, or if 
they have a great nanny they no longer need. We met with the 
information technology guy, Kevin, who was helpful. We left 
with a list of things to do, all doable. I think it will happen! 

Every month we put a new "Quote of the Month" on the 
Women Faculty Affairs website. This month we're posting a 
poem by Emily Dickinson. I think you'll like it. 

Hope is the thing with feathers by Emily Dickinson 

Hope is the thing with feathers 
That perches in the soul, 
And sings the tune without the words, 
And never stops at all, 

And sweetest in the gale is heard; 
And sore must be the storm 
That could abash the little bird 
That kept so many warm. 

I've heard it in the chillest land 
And on the strangest sea; 
Yet, never, in extremity, 
It asked a crumb of me. 




From: Laura 

Sent: Sunday, April 15, 2007 7:29 PM 

To: Jennifer 

Subject: Bird by Bird 

Hi Jen. Today I spent most of the day rereading one of 
my favorite books, Anne Lamott's Bird by Bird. Although the 
book is ostensibly about writing, it might just as well be about 
dealing with cancer. The title story is derived from an incident 
in which the author's big brother, as a kid, was assigned to write 
an essay about the birds of North America. He found the task 
overwhelming. When his father asked him what the problem 
was, Lamott's brother said that there were a lot of birds in North 
America. His father looked at him reassuringly and said, "Bird 
by bird, buddy. Just take it bird by bird." 

The story reminds me of advice Maureen gave me 
shortly after I was diagnosed, when I was considering declining 
treatment. She told me I don't have to agree to the whole deal; I 
could just agree to start, and then take it one day at a time. The 
advice was comforting. This approach let me maintain the 
illusion of control ("it's no illusion; you ARE in control," 
Maureen would say). It also broke up the impossible task of six 
months of chemo into a series of manageable tasks, dealing with 
each individual day. I would do it bird by bird. 




From: Laura 

Sent: Monday, April 16, 2007 4:56 AM 

To: Jennifer 

Subject: Broadway 

Hi Jen. Q and I went to see the Eugene O'Neill play 
"Moon for the Misbegotten" starring Kevin Spacey on 
Broadway yesterday, and it was fabulous. I decided to wear a 
hat that didn't go up too high on my head, so I wouldn't block 
the view of the person sitting behind me. I chose the Reese 
paisley, which has a fabric slouch crown with a split cuff brim 
and a "self trim," which means part of the same fabric as the hat 
serves as the trim. The fabric is a subtle silver, beige, and black 
paisley pattern, with a small sewn silk flower at the side. 

The play was great, but it desperately needed editing. If 
I were an English professor, I would assign my students to cut 
an hour off of it — the run time was almost 3 hours. It took me 
two nausea pills at $40/pill (that Zofran is worth its weight in 
gold) to get through the play. If the play had been an hour 
shorter, I could have done it in one nausea pill. Do you think the 
estate of Eugene O'Neill would listen to reason? They owe me 
40 bucks. 

The hardest part of the outing was afterwards, when Q 
and I went to get a cab. It was rainy and the streets were 
slippery. As I was getting into the cab I slipped and almost fell, 
and then hit my head (the part with the Omaya) against the cab. 
I started to cry. Q helped me up and pulled me into the cab and 
gave me a hug, which I desperately needed. I try to be brave and 
optimistic about all this, but the bottom line is that cancer 
makes you feel vulnerable, and I used to feel invincible. 



I don't remember if I told you — I started having severe 
visual blurring, which is bothersome, because reading and 
writing are integral in my life right now. The blurring began 
around the time I started my latest course of prednisone. Sam. 
my neurologist, said that visual blurring is common on 
prednisone. Apparently the symptoms can be triggered by either 
raising or lowering the steroid dose but usually disappear after 
steroids are stopped. Steroids can also cause cataracts or 
glaucoma. These possible side effects are not good news, but all 
of them are better than having the visual blurring represent 
worsening lymphoma in my eyes. Yesterday I took my last dose 
of prednisone for the month, so hopefully the symptoms will 
improve. I'm still going to see the eye doctor to make sure. 

My father is on my mind a lot these days. I'm listening 
to piano music that he played, like Schumann's Kreisleriana; he 
especially liked part 1. for which the tempo marking is 
"agitatissimo." or very agitated. The piece is fiendishly difficult, 
requiring a massive reach for both hands. My father used to tell 
me how Schumann injured his right hand, possibly as the result 
of a mechanical device he used to increase the strength, 
independence, and span of his fingers. Apparently Schumann 
became psychologically unstable, and spent the last two years 
of his life in a mental institution. Schumann's wife. Clara, an 
excellent pianist who was the daughter of Schumann's boyhood 
piano teacher, was the one who held it together in their family. 
Any frustration my father ever felt was released in the Olympic - 
level workout of the Kreisleriana. 

My father loved to play Beethoven sonatas, especially 
the ones that were the most technically challenging. I've been 
listening to one of his favorites, Beethoven's "Appassionata" 
Sonata #23 Op. 57.1 remember him playing the third movement, 
with a tempo marking "allegro ma non troppo" (fast but not too 
fast). As I watched his fingers fly across the keys, I doubted that 



it was possible to play it any faster. My dad used to tell me that 
Beethoven started to lose his hearing in his twenties and was 
completely deaf by age 50. It struck me as ironic that a man 
who was so passionate about composing music lost his hearing. 
I thought about Beethoven going deaf when my father lost his 
manual dexterity and his piano playing after a stroke. 

I've been listening to Mozart sonatas that my father and 
I played together. One of my father's favorite books was a 
biography of Mozart by Marcia Davenport. My father loved to 
tell me stories about Wolfgang Amadeus Mozart: when Mozart 
was three, he watched his older sister Nannerl play the piano; 
when he was four, his father Leopold started to give him piano 
lesions; he began composing at age five; and he spent his 
subsequent childhood traveling with Leopold all over Europe, 
performing as a child prodigy. My dad always said that Mozart 
wrote more than 600 priceless compositions, but died "a poor 
churchmouse" at age 35. 1 knew that if my dad had been 
Wolfgang's father, he would have encouraged him to find a 
better paying job. 

One of the first pieces my father and I played together 
was the Mozart Sonata for 1 piano, 4 hands, in D Major, KV 
381/123a. I used to laugh when our hands got tangled up as one 
of us reached over the other for a trill or arpeggio outside of our 
own "turf." As I got older, we each wanted to have an entire 
keyboard to ourselves, so we preferred music for two pianos, 
like the Mozart D Major Piano Sonata, K. 448. To this day, D 
Major still feels to me like a joyful key of innocence and youth. 
Listening to the music my dad played, and especially to the 
music we played together, makes me feel like he's up there 
looking out for me. 




From: Laura 

Sent: Monday, April 16, 2007 5:22 PM 

To: Jennifer 

Subject: Emily Dickinson 

Hi Jen. Today at work I wore a hat called the Roz, a 
two-piece cloche in black and brown with a curved pheasant 
feather rising up from the side. On the way to a meeting, I was 
in the elevator with an elderly couple. The wife was looking at 
me and speaking to her husband in Italian. I smiled at her and 
said, "You're talking about my hat, aren't you?" And she said to 
me in a thick Italian accent, "Yes. I love your hat!" When I'm 
wearing these hats, I never worry about making conversation. 

I found a poem that captures my feelings about how I 
want to use my experience with pain to help others: 

If I can stop one heart from breaking by Emily Dickinson 

If I can stop one heart from breaking 

I shall not live in vain; 

If I can ease one life the aching 

Or cool one pain, 

Or help one fainting robin 

Unto his nest again, 

I shall not live in vain. 




From: PWF A/President's Office 

Sent: Monday, April 16, 2007 12:48 PM 

To: All Women Faculty 

Subject: Athena Tuesday 4/24, 5 pm 

To Women Faculty: 

Please come to the next ATHENA, our informal women 
faculty group, on Tues 4/24 5-7 pm, Faculty Club. Come for a 
few minutes or stay longer. I hope you'll join us! 

Best wishes 

Laura Liberman, M.D. 

Director, Program for Women Faculty Affairs 

From: Laura 

Sent: Monday, April 16, 2007 7:58 PM 

To: Jimmie 

Subject: Your amazing book! 

Hi Jimmie. Thank you for sending me your amazing, 
wonderful, awesome, incredible book, The Human Side of 
Cancer, which is exactly what I need to read right now! I feel 
like you wrote it for me. After I finish reading it, can we talk? 
You are a fantastic writer! 

Also, thanks for sending me the Stephen Gould book, 
Full House: The Spread of Excellence from Plato to Darwin. I 
especially liked the chapter called "Case One, A Personal Story: 



Where any measure of a central tendency acts as a harmful 
abstraction, and variation stands out as the only meaningful 
reality." Basically, Gould seems to be saying that even if the 
median survival of your cancer is 50% at one year, that means 
half of the people with that cancer live less than one year, but 
half live more — and some people may live ten, twenty, thirty 
years or longer. This news is particularly good for people like 
me, who are told that their illness has a lousy median survival. 
When I saw Figure 7 on page 55, 1 imagined myself way on the 
right, at the highest end of the survival bell curve, waving and 

Your book and Gould's should be recommended for 
every cancer patient. 

Best wishes 

From: Laura 

Sent: Tuesday, April 17, 2007 2:13 AM 

To: Jennifer 

Subject: Nate's college forms 

Hi Jen. Nate is working on his college applications. We 
started to talk about colleges last summer (the summer before 
his junior year) when we were on vacation in Hilton Head, 
South Carolina. Nate and I biked over to the only tiny book 
store in town and bought the one copy of the Fiske Guide to 
Colleges. I suggested that Nate make an Excel spread sheet 
listing the colleges he was considering and their characteristics, 
to organize his thinking. It was an opportunity for me to teach 



Nate an important lesson: many of life's problems can be solved, 
or at least helped, by a good Excel spreadsheet. 

Today Nate started to work on the nitty gritty of 
applying to college. The process at Nate's school is very 
organized. They have all these forms and questionnaires for the 
students to fill out in preparation for a meeting with the college 
counselor. Students have to express their interests, talk about 
the subjects they enjoy, and describe what their extracurricular 
activities have been. The parents have to fill out forms too. 
Nate's interests have been non-traditional, centering on teaching 
and community service. 

Nate's first exposure to working with kids was when he 
was in fifth grade, and his elementary school partnered each 
fifth grader to a first grader in their "buddy class." The summer 
after eighth grade, Nate was a camp counselor for a group of 5- 
year-olds. I know the students adored him because one summer 
day a 5-year-old girl in his group recognized him as we were 
walking down the block and ran up to him to give him a hug. 
She hugged his knees, because they were as high as she could 
reach. The girl's mom, who recognized Nate, said to her 
daughter, "Do you know who that is?" And the girl said, 
"That's Nate, my counselor!" as if he were a rock star. 

When Nate went to high school, he started tutoring 
third-graders in a bilingual Spanish/English public school on the 
West Side. One student drew a crayon picture of Nate as a 
superhero, complete with uniform, sword, and shield; it's still 
hanging on Nate's wall. Nate told us about a girl in the class 
who failed a math test. On one question in which she was asked 
to draw a triangle with vertices C, A, T, she had drawn a cat, 
not a triangle. Instead of berating her, Nate commented on the 
realism of her drawing, and asked, do you have a cat? What's 
the cat's name? What kind of cat is it? The girl was so engaged 
that when he started to explain the math to her, she listened. 



During the summer after he finished ninth grade, Nate 
volunteered at a neighborhood soup kitchen that gave groceries 
to individuals and families in need. I thought it was just a 
summer gig, but he kept it up weekly throughout high school. 
He rose through the ranks and eventually ran the line for 
distributing food to the elderly and disabled. I was proud of his 
dedication. During the subsequent summer and school year, he 
also volunteered to teach in a program to help low-income New 
York City elementary school kids prepare to apply to 
challenging public or private high schools. A student of Nate's 
became one of the first three students in the program to get 
admitted to a New York Independent School. Nate described 
these experiences in his college essay. 

I like the way Nate writes: get your thoughts down on 
paper first and edit later. That's a method Anne Lamott suggests 
in the chapter "Shitty First Drafts" in her book, Bird by Bird. I 
think getting any thoughts down on paper and then cleaning it 
up is a great strategy because it takes an impossible task (taking 
the blank page and filling it with a beautiful story) and breaks it 
into two smaller, easier tasks (writing the "shitty first draft," 
and then editing work you've already written). 

It wasn't only Nate writing today — David and I had to 
fill out parent college forms. In addition to the name, rank, and 
serial number stuff, they asked us to specifically name where 
we would like him to apply to college. We wrote down that we 
wanted him to go where he wants to go, so he can be happy. I 
don't understand pressuring your kids to go to the same school 
you did. Your kids are not you; they have their own tastes, 
interests, and abilities, and need to find schools that are right for 

The college application process with Nate has taught me 
that parenting a teenager is like getting a bird to eat out of your 
hand. You love the bird; you want to feed the bird; you have 



only the bird's best interests at heart; you would never, ever hurt 
the bird. But if you make big sudden movements, the bird will 
fly away. You have to be casual. You stroll over, toss out a few 
seeds, and step back, like you don't even notice. Maybe he won't 
come at first. But then each day you put out a few more seeds 
and step back. Eventually he may come, and maybe at some 
point (if you're very lucky!) he'll take a seed before he bolts and 
then another and another and finally one day you'll feel the 
tickle of his beak in your hand before he flies away. 


From: Laura 

Sent: Tuesday, April 17, 2007 9:40 AM 

To: Maureen 

Subject: Athena 

Hi Maureen. Question for you. There is an Athena 
gathering on Tues 4/24 from 5-7 pm in the Faculty Club. I am 
getting admitted for chemo that day. Can you lead this Athena? 
There are a few announcements to make, and basically I want 
someone to be there to make people feel welcome. Would this 
be OK? 

Do you want to pop by here this morning (I'm in the 
women's office) and catch up for a few? I'm going to the Junior 
Faculty Council meeting at noon. 

I'm doing OK. Intrathecal chemo Thursday, another 
admission Tuesday. Have finished seven of 18 doses of 
chemo — only 1 1 left. After the next admission is done, I'll have 
finished nine of 1 8 chemos — the halfway mark. 




From: Laura 

Sent: Thursday, April 19, 2007 2:08 AM 

To: Jennifer 

Subject: Seminar 

Hi Jen. I loved what you said about how nobody calls 
you Jenny. It's like with Nate. When he was born, David and I 
named him Nathaniel, and figured we would call him by that 
name. But from the moment of his birth, he's been such a 
thorough and complete Nate. We have a video of bringing him 
home from the hospital right after he was born. We carried him 
over the threshold and said, "Welcome home, Nathaniel." I 
don't think we've called him Nathaniel since. I remember once 
when he was three, a friend's mom called him "Nathaniel." 
Nate said, "Don't call me Nathaniel. My name is Nate!" I was 
shocked that my three-year-old was so certain of his own 
identity. On rare occasions, some people call him Nathaniel, but 
he's mostly Nate to those of us who know him best. 

I went to a fabulous career development seminar today. I 
wore a hat called the Tracy, which had a beige straw cloth 
square crown with a large down brim and muted green hand 
rolled roses. The seminar was jointly run by Cornell, Columbia, 
Sinai, Einstein, and NYU. Sometimes these seminars get a little 
whiney, but this one had the best speakers, and there were 
terrific people to meet. 

A woman who is Director of Diversity at Columbia 
University spoke about diversity in the workplace, and was 
absolutely spectacular! She talked about how people (women 



and men) are looking for balance in their lives now, and it's no 
longer acceptable for many of them to work 24/7. 1 know this to 
be true. I also think we pay the consequences for our overwork. 
Relentless stress takes its toll on our psyches, bodies, spirits, 
and families. 

We have to figure out a way to let people work but also 
let their work lives fit with the rest of their lives. Even if the 
goal is simply to get as much work as possible out of a person, 
it is better strategy to allow them to try to make the pieces fit. 
Life is a marathon, not a sprint. If you give all your steam on 
the first leg of the relay you'll have nothing left for the finale. I 
know that this is true, but how do we make it a reality when we 
are all such Type A personalities, want nothing short of 
perfection, and work in a cancer hospital where the stakes are 
high and mistakes can have lethal consequences? 

Another amazing speaker at the conference was named 
Catherine J. Morrison, J.D. She gave two terrific sessions, a 
general lecture on negotiation and a seminar on conflict 
resolution. I especially liked her Frank Zappa quote: "Reality is 
an optional experience!" I'm going to follow up with her and 
see if she can give a session for our women faculty. 

At the seminar, a female junior faculty member who 
took a grantwriting course sponsored by Women Faculty 
Affairs just found out that she was awarded her grant from the 
National Institutes of Health! Isn't that fantastic, wonderful 
news? This Women Faculty Affairs job is great — I get to play 
Point Guard. I feel like Teresa Weatherspoon of the New York 
Liberty in the WNBA: I get the ball to the Center, and she gets 
it into the net. 

The seminar was held at Columbia University, which is 
gorgeous — a beautiful college campus right in the middle of 
New York City. After the seminar, I went to the college 
bookstore and bought a CD of classic Beatles tunes to put on 



my iPod. I'm still listening to a lot of music these days, 
especially when I'm in the hospital or getting chemo. 

The only bad thing about today is that my vision is still 
blurry. It's hard to see the traffic signs across the street. I never 
realized how scary it is to go out in the world unable to see. 



Chapter 10 
Good News, Bad News 

7/ 's OK to cry, but do so <20 minutes/day. 

From: Laura 

Sent: Thursday, April 19, 2007 9:28 PM 

To: Jennifer 

Subject: Good news/bad news 

Hi Jen. I got good news and bad news today. The good 
news is that my visual blurring is probably due to prednisone. 
The bad news is that my cerebrospinal fluid (CSF) won't 
clear — it still has atypical lymphocytes. If these lymphocytes 
are lymphoma, and they can't get rid of them, I probably won't 

Now I'm going to go cry (less than 20 minutes), and then 
I'll sit at the lap top and write and feel better. There's more to 
tell but I'm exhausted. I'll write later. 


From: Laura 

Sent: Friday, April 20, 2007 1:28 AM 

To: Jennifer 

Subject: Highs and lows 

Dearest Jen, 



OK, I'm here to fill in the details about yesterday, which 
was the toughest day I've had yet. Emotional highs and lows. 
I'm exhausted thinking about it and it hurts to tell it, but it's 
going in the book, so I better go ahead. 

It started with an appointment with the ophthalmologist. 
I told you I've been having blurry vision for about a week now, 
since I got the last dose of R-CHOP. My near vision is OK, but 
my distance vision is screwed up. When I went to the play on 
Sunday, Kevin Spacey was a fuzzy blur moving across the stage. 
Having blurry vision in the middle of Manhattan is scary. But 
the most terrifying thing about the blurry vision was thinking 
about what it could mean. The blurry vision may be from the 
prednisone, which changes the curvature of the lens of the eye 
(the lens gets swollen and puffy like everything else on steroids) 
or it could be from worsening lymphoma in the eyes. 

I saw Jack, the ophthalmic oncology guy recommended 
by my neurologist. Jack is a man of few words, tall and thin, a 
little older than me, personable, and extremely knowledgeable. 
He tested both eyes, took measurements for a new prescription, 
and said that my blurry vision is because of the steroids. 
Decline in vision is apparently very common, particularly at the 
beginning of R-CHOP treatment, and usually stabilizes at a 
certain point. He saw no abnormal cells in my eyes, so it's NOT 
worsening ocular lymphoma. He wants me to come back on 
Monday so that he can recheck my vision, and if Monday's 
prescription is stable from yesterday's, he wants me to get new 

I was thrilled about the good news. The ability to see 
(which lets me read and write) is essential for me. If I have to 
choose between seeing and hearing, I'd pick seeing, although I 
hope I won't have to make that particular choice. 

I had another intrathecal chemotherapy. I was starving 
and brought my lunch (a fresh salad that I made in the cafeteria) 



with me to eat while I was waiting for chemo. When Phil came 
in to tap the Omaya and I was eating a salad, he said, "You're 
eating before the chemo?" I told him that I was hungry, and that 
I also wanted him to see what I was having for lunch, because I 
knew he would not want to make me throw up and see it a 
second time. I told Phil that I had learned that if I throw up, it's 
because he's injecting too fast. I said that if that happens, I'm 
going to aim directly for his soft brown leather imported Italian 
shoes, and that when I take aim, I do not miss. Guess what? Phil 
injected slowly, and I didn't puke! Afterwards, I sat with Cindy 
and she held pressure on my head (which bled awhile) until I 
felt OK. 

After we finished the intrathecal chemo, I had a serious 
discussion with Phil about the fact that my CSF (the 
cerebrospinal fluid surrounding the brain and spinal cord) has 
not cleared. Yesterday was my fifth dose of intrathecal 
methotrexate. Before each injection of intrathecal methotrexate, 
they take out some fluid (called "tapping the Omaya") and send 
it to the lab so they can analyze the cells under the microscope. 
We had originally planned six doses of intrathecal chemo, and 
Phil had thought that the CSF would clear after the first dose or 
two. Unfortunately, my Omaya taps still show atypical 
lymphocytes. Phil's sending the fluid from yesterday's tap for 
fancy tests (including something called "flow cytometry") to 
find out for sure whether these cells are lymphoma, but he 
suspects that they are. I should get those results on Monday. 

If the flow cytometry is negative (meaning no 
lymphoma cells from the Omaya), then after my third cycle of 
chemo is done, they're going to do a lumbar puncture (LP, or 
spinal tap). I asked Phil why we need the LP if he's tapping the 
Omaya, and he said that the CSF around the brain (which is 
what you get in an Omaya tap) and the CSF around the spinal 
cord (which you get by doing an LP) mix with each other but 



sometimes the mixing is incomplete, and what you find in one 
might be different than what you find in the other. We'll need to 
send the fluid from the LP for flow cytometry also, so that we 
can thoroughly analyze all of the CSF for the presence of 

Phil is thinking about changing me to even stronger 
intrathecal chemo. I'm worried. The intrathecal methotrexate 
I'm on now is tough to take, and I'm concerned that if they hit 
me with more aggressive intrathecal chemo for worsening 
lymphoma, either the stronger chemo or the lymphoma or both 
will kill me. I'm trying to stay positive and I'm still hoping to 
blow this cancer thing out of the water, but I'm also terrified of 

After my appointment, Cindy took me home in a cab. 
On the way home, she said she was going to be in the city on 
Saturday, and asked if I wanted to meet at St. Patrick's 
cathedral so we could light candles. It sounded like a 
comforting thing to do, so I said yes, and we made plans to 
meet there at 4 pm on Saturday. 

When I got home, I was upset about two things. First, 
there is a chronic leak in our master bathroom, which has been 
overgrown with fungus for months. It could probably kill a 
healthy person, but with my low white blood cell count it is a 
death zone. Second, we have a beautiful terrace on which we 
planted flowers and trees a few years ago. For the past two 
summers, they've been doing construction on the terrace. They 
killed the plants, broke the glass window panes, moved away 
our table to make room for their equipment, and rendered the 
space unusable. Now that I'm sick, I want to sit out there when 
the weather is warm enough and bring my lap top and write. 

David has spoken multiple times to the new super about 
these problems (the old super was a crook who took bribes and 
got fired). The new super keeps saying that he will take care of 



these things, but it hasn't happened yet. So today I had enough. 
I intercommed the front desk and told them to send me the 
super, that I had to speak to him personally. Nate and Carmen 
were here. I told them to get ready for a scene. 

Jesus, the new super, came. He is a quiet man in his 40's, 
with a Spanish accent, medium build, and dark hair. I greeted 
him with no hat, bald. I told him that I have cancer, that I'm 
getting chemotherapy, and that there is a good chance that I'll 
be dead within a year. I told him that I need him to get the 
terrace finished so that I can sit out there. I showed him every 
item on the terrace that needs to be fixed. Then I asked him to 
go into our disgusting fungemic bathroom and told him that the 
doctors said that this could kill me if it is not corrected 
immediately. I told him that if I died because of the fungus in 
the bathroom, he was responsible for my children losing their 
mother. I screamed, I cried, and I begged him in the name of 
God to help me. 

By the time I was finished, poor Jesus was a shaking 
shell of a human being. This quiet God-fearing gentleman had a 
hysterical bald woman on his hands. I must have lit a fire under 
him. He made a bunch of calls; he promised he would take care 
of it; he gave me a hug and kissed my hand; and he said he goes 
to church every day and will pray for me. He gave me his cell 
phone number and told me I could call him any time of the day 
or night. And then he left, but he must have been upset, because 
he left his wallet in our apartment and had to come back to get it. 

After the scene with Jesus, Emma came home. I had to 
have a heart to heart talk with Emma about a bunch of things. 
I've been showering in her bathroom in the mornings because 
I've been afraid to go in the death zone of our master bathroom. 
Sometimes the sound of my showering wakes her up. This 
morning I couldn't find the hat I wanted to wear, and I looked in 
her room, and I kept knocking on her door to come in, which 



interrupted her sleep. And she hadn't slept well the night before. 
I knew she was irritated, but my kids don't want to be mad at 
me these days because I'm sick. I apologized for interrupting 
Emma's privacy to look for the hat. I told her I won't leave my 
hats in her room anymore. Together, we made a plan for when I 
can use her shower without disturbing her. I told her that it's 
OK for her to be upset, and that I was glad we could talk about 
what's been going on. 

David came home. Jesus had called him, and David 
wanted to know what had happened. I explained the scene, after 
which David came up with all sorts of reasons why the plan of 
fixing the bathroom couldn't work. The Super had asked 
Carmen to clean out the bathroom, and Carmen started saying 
that she would do it in the morning. And then I lost it. David, 
Carmen, Emma, and I were in the family room, and Nate was in 
the living room at the table, working with his SAT II tutor. I 
started to scream. 

I screamed that I needed them to do what I asked exactly 
the way I wanted. When Carmen asked me why I was getting so 
upset, I screamed "BECAUSE I'M SCARED I'M GOING TO 
today that the CSF is not clearing, and I know that if the CSF 
doesn't clear, I won't live. I'm making the best effort I can to 
beat this thing, but ultimately whether I survive is beyond my 
control. Although there is a lot about which I can't call the shots, 
I'd like to control the few things I can. I want to sit on the 
terrace. I want a bathroom that is free of fungus. I want the 
people I love to help make that happen, and not tell me a 
thousand reasons why they can't. I hadn't even realized that was 
what made me so upset, and once I did and told them, they 

Poor Nate. He overheard my scream about "I'M 
SCARED I'M GOING TO DIE" in the living room with his 



tutor. Apparently he looked up sweetly at her and said in a calm 
voice, "I think we're done." She initially thought the screaming 
was from the neighbors, but apparently I screamed again, and 
then she realized, "The call is coming from inside the house." 
Nate is so funny when he tells the story. 

I'm not scared of dying for me; I don't want to leave 
David and Nate and Emma. They deserve more. 



Chapter 11 
Test Results 

Ask people to pray for you. Get in shape. Go iPod. 

From: Laura 

Sent: Friday, Apr 20, 2007 2:17 AM 

To: Phil 

Subject: Treatment thoughts and questions 

Hi Phil. Question: will I be getting intrathecal chemo 
when I see you at 9:45 am this Tuesday, prior to my admission 
that day? And do I come straight to you first for the 
appointment, and then go to the Admitting Office afterwards? 

Don't worry about the ridiculously early time on the 
email. My sleep schedule is odd, but I'm getting enough sleep. I 
usually take my evening pharmacy of medicines around 8-9, 
sleep about four or five hours, wake up and write for a couple of 
hours, and then go to sleep until somewhere between 4 and 6 
am. So I get about 6 hours of sleep a night (I have never been a 
good sleeper). The prednisone may contribute but I have a 
similar pattern off steroids. 

I keep thinking about our last visit. I had so wanted the 
CSF cytology to clear and I'm concerned that it may not be 
clearing. If you need to switch to a bigger intrathecal gun, I will 
do it. But I also wonder if there is still the possibility that these 
cells in my CSF and I can co-exist, because maybe what I have 
is a weird thing on the cusp between autoimmune and malignant. 
Maybe we could treat until the cows come home and I'd still 
have funky lymphocytes in the CSF, and maybe it would be OK. 
I don't want you guys to treat my numbers and kill me in the 



process. Please keep that in mind when you talk to Sam after the 
flow results are back. And please keep me in the loop. 

I was so relieved when Jack said he thought the visual 
trouble was from the steroids and not worsening lymphoma. I 
am paring down the faculties I absolutely need to live a happy 
life, and unfortunately vision is among them. 


From: Laura 

Sent: Friday, April 20, 2007 4:36 AM 

To: Gerald 

Subject: Help 

Hi Gerald. We don't know each other well, since you 
just joined us at Memorial a few months ago, but I'm a long- 
standing fan of your cancer research. That's why I'm asking 
you for help. 

This winter, I was diagnosed with disseminated 
lymphoma and started treatment with R-CHOP, intrathecal 
methotrexate, and high dose IV methotrexate at Memorial. A 
recent Omaya tap showed persistent atypical cells in my CSF. 
Phil, my oncologist, sent flow cytometry yesterday, which is 
pending. He says that if the atypical cells are lymphoma, we 
have to switch to stronger (and potentially more toxic) chemo. 

Can you look at my lymphoma cells and design a 
targeted drug that would destroy my lymphoma cells and not 
kill the rest of me? I know you've been successful using this 
approach before in non-lymphoma cancers. I love my family 
more than you can imagine, and I'd like to have the chance to 
grow older with my husband and watch our kids grow up. I 



know that this kind of research can take years, and I may not 
have that kind of time. 

As cancer doctors, we're trained to accept dying as a 
part of life. Now that I'm on the other side, I see how hard it is 
to stare death in the face and confront the possibility of leaving 
the people you love. I realize that my request is enormous (if 
not impossible), but if anyone can do it, it's you. 


From: Laura 

Sent: Saturday, April 21, 2007 7:25 AM 

To: Jennifer 

Subject: Movie 

Dearest Jen, 

I can see that you really read my emails — you rattled off 
a list of the people who make up the cast of characters of my 
life as if you had been there living it with me (which you are, in 
spirit!). I'm also glad you don't think my outburst traumatized 
my kids for life. That helps me a lot, coming from you. 

You'll be delighted to hear that yesterday (Friday) was 
much better than Thursday! It started in the morning. The super 
was coming up to meet with David about the terrace and the 
bathroom. Nate thought that if I saw Jesus again I would 
explode, so he wanted to make sure that I wouldn't have any 
contact with the super. He told me that when the super comes, I 
should either go into another room or leave the apartment. He 
refused to go to school until David promised him to make sure 
that I did one or the other. Emma had already left, so I went into 
Emma's bathroom to take a shower, and stayed there with the 



door closed until David came in and told me that the super was 

Apparently it went well with the super. Jesus told David 
that they would finish the terrace within the week, and that the 
painters were coming in an hour to work on the bathroom. Jesus 
also told David that he has a prayer group, and he would like to 
bring his three friends over to pray for me. So I have to set a 
date to have the super's praying buddies make a house call! 

I wanted to leave before the painters got there, because I 
knew it would make me upset. Luckily I had a good place to go. 
My friend Terri, an oncologist who makes documentaries about 
people living with cancer, had asked me to be in a film she was 
making called "The Physician as Patient," and she was filming 
that day. I had to pick the right clothes for the movie. I ended up 
wearing a muted purple silk shirt, a patterned multicolored 
yellow and purple skirt that I bought in St. Johns once on a 
Caribbean vacation, and a sweater in a combination of gold and 
purple. The most important decision, of course, was the hat. I 
picked a hat called the Butterfly, which is a soft mauve crown 
with medium brim and a muted gold silk organza butterfly- 
shaped bow. 

To kill the time between 9 am and the movie shoot at 
1 1:30 am, I went to our new clinical offices at 61st St. I wrote 
you when I saw the bare suite, but I haven't been back since 
everybody moved in. They moved offices when I was just 
starting treatment. I've had many prior office moves in the 
hospital and previously I've always packed and moved myself, 
meticulously labeling every box with books, journals, articles, 
and other items. This time, I didn't pack or move a single thing. 
I delegated it all to Lea, who did a spectacular job. She had even 
hung my pictures on the walls, so it really seemed like my 
office. And the windows that I was so excited about when I saw 
them for the first time — Jen, they actually open! And I look 



right at a huge sign that says Bed, Bath, and Beyond. The office 
is about twice the size of my previous radiology office, and the 
sun streams in through the windows. 

Around 1 1:00 I left to go to the St. Regis Hotel, on 5th 
Avenue and 55th St. The hotel has an ornate lobby with lots of 
gold trim. I asked at the front desk where Terri was making the 
film. They told me the suite and I went up. When I entered the 
suite, they had just finished filming an 81 -year-old doctor who 
had previously had head and neck cancer and now had prostate 
cancer. I chatted with him and his wife for awhile. Then the 
couple left and they set up for me. 

The make-up part was a riot. I had blush, some kind of 
powder, and lipstick that I borrowed from Emma, but since I 
never wear make-up, I didn't know how to put them on. Terri 
and I went in front of the mirror in the bathroom, a room that is 
bigger than my entire apartment, and she applied the makeup to 
my face. She is absolutely meticulous — things had to be exactly 
balanced on both sides — it was like having Monk as your make- 
up artist! Emma's lipstick was too orange for me, so I did a trick 
that the cameraman from India suggested. There was a bowl of 
raspberries in the room, so I rubbed some raspberries on my lips 
to make them red. Apparently that is how the queens in India do 
it, so I guess now I have the qualifications to apply for a job as 
an Indian Queen. 

The filming was done in the living room of the hotel 
suite, with overstuffed chairs, huge picture windows, and cut 
lilies in the background. It was a little hot in the room so they 
put on the air conditioning. I sat in the chair and I was wired up 
so tightly with mikes that I probably couldn't have escaped if I 
had wanted to. The film crew was two guys: Chris was in 
charge of the camera and Alex was in charge of sound. They 
were very friendly and joked around to try to put me at ease. 



When it was time to start, Terri sat in the chair opposite 
me and asked questions. I got to tell a lot of my stories 
(although I left out the one about the panties and the brain 
surgery) and we talked about stuff I haven't really fully 
articulated in my mind (eg do you believe in life after death, do 
you believe in God, etc.). She asked questions about whether I 
got nervous waiting for test results, and I said not really. It's 
interesting that I said that — in the moment I completely forgot 
how terrified I am waiting for the results of the Omaya tap to 
see if the CSF has cleared. I guess the mind compartmentalizes. 
I had to take a couple of nausea pills to get through the filming. 
Afterwards, we went to a little outdoor plaza nearby to take 
some still photos. 

Later, I met my friend Karen for tea. She's a breast 
imager from California and was in New York to visit her 
daughter. I've always admired her, because she does terrific 
work while still managing to keep her priorities straight. If she's 
invited to give a talk and she has family plans, she will do the 
family stuff and blow off the meeting. Her daughter is a 
sophomore at Columbia, studying Hispanic Studies and Human 
Rights. After tea, we walked back to my apartment and met up 
with her daughter. I took them for a walk on the boardwalk by 
the East River, and then I brought them home and introduced 
them to Emma and Nate. They left before dinnertime. 

I was afraid to look in the bathroom until David got 
home, because I knew if I saw the fungus again I would lose it. 
When David came home, we looked at the bathroom together. 
Jen, it was a miracle. Those painters had scraped everything 
down to the bone, it was pure white, and the fungus was GONE. 
So it was worth it. One less thing trying to kill me. 

That's all for now. Today I'm going to St. Patrick's 
cathedral to light candles with Cindy. 




From: Laura 

Sent: Saturday, April 21, 2007 9:56 PM 

To: Jennifer 

Subject: Lighting candles 

Hi Jen. Cindy and I met this afternoon at St. Patrick's 
cathedral, as planned. It was a gray day, lightly drizzling when I 
got there. I was wearing a black hat called the Lachlan, which 
has a square crown, medium brim bucket, and knot trim, in a 
soft waterproof fabric. The hat was perfect for the rain outside, 
but was hot in the church, so once we were inside, I took off the 
hat and put on my Monk cap, which I had stuffed into my purse. 

I had never been inside St. Patrick's before. It was like a 
European cathedral. Incredibly high ceilings, ornate gold 
everywhere, and stained glass windows in vibrant colors with 
light shining through. When you come in, there's a marble 
water fountain on your left, which Cindy said has holy water. I 
asked whether you drink it, and she said no, you bless yourself 
with it. Apparently you are allowed to bring a bottle with you 
and take some holy water for the road. I dipped my fingertips in 
it and sprinkled some on my head and shoulders. 

We walked around the church. In the center were 
multiple long wooden benches. At the periphery were statues of 
saints, each enclosed by a couple of marble steps and a small 
fence. A little plaque near each saint explained the name of the 
saint and what the saint stood for. To your lower left as you 
looked at the saint, there were bins that had many round, 
relatively flat, unlit candles. More centrally, there were several 



rows of small glass cups, some with lit candles inside. The 
round candles fit perfectly into the glass cups. There was 
another bin full of wooden sticks, thinner and longer than 

If you want to light a candle to a saint, you pick up an 
unlit candle, gently pull up the wick so that it's standing rather 
than flat against the wax, and drop the candle into an empty 
glass cup. You take one of the wooden sticks, put the tip in the 
flame of one candle, and use that to light your candle. After the 
candle is lit, you can blow out the flame on your stick or 
extinguish it by putting it directly into this thin rectangular 
planter full of dirt. We enjoyed putting it into the dirt, because it 
made a satisfying little hissing sound as the fire went out. 

Cindy recognized the saints, although I didn't know 
most of them. I read all the cards. I was looking for a saint for 
47-year-old women with lymphoma. None of the saints exactly 
fit the bill, but I was able to find saints for the sick, the dying, 
the departed, and people in need. I figured close enough, and lit 
the candles. After we had walked halfway around the church, 
there was a quiet area with several benches separate from the 
main central portion of the Cathedral. From the benches, there 
was a beautiful view of the stained glass windows and an altar 
at the front. We sat there quietly for awhile. Then we got up, 
looped around the other side of the church lighting candles for a 
few more saints, and left the cathedral. 

Although it was near dusk, the light outside glared after 
the dim of the church. It was also jarring to come out of the 
cathedral and immediately be inundated by the bustle and 
commercialism of New York City, including an Armani 
Emporium right across the street. Cindy and I didn't talk much. 
It had stopped drizzling by then. We walked back to the Upper 
East Side, where Cindy had parked her car. We gave each other 



a hug. She got into her car and I hopped a cab back to my 

I know that lighting candles in a cathedral is an odd 
experience for a nice Jewish girl. I'm not a born again Christian 
(or any kind of Christian). When I was growing up, my parents 
shared a strong sense of Jewish cultural identity but weren't 
religious — my dad used to say that many atrocities in world 
history were committed in the name of God. But confronting the 
fact that I might die makes me look for answers and spiritual 
solace wherever I can find them. I need to connect with other 
people, with the universe, and with what, if anything, is beyond 

Tomorrow, back to earth. Emma and I have tickets to 
see a Broadway show. 


From: Laura 

Sent: Sunday, April 22, 2007 6:18 AM 


Subject: Invitation 

Dearest Q, 

I'm writing this letter to invite you, Steve, Nick, and 
Ben to our "re-wedding." David and I are going to celebrate our 
25th anniversary by getting unofficially married again. We're 
hoping to have the celebration on Sunday June 10 (the actual 
anniversary is June 13), either on our terrace if it's ready or in 
Carl Schurz Park if it's not. It will be very simple — just the 
eight of us (no rabbi or other officiating person) and we'll read 



something out loud and give each other a hug and a kiss and 
that's it. Afterwards we'll have dinner. Can you join us? 


From: Laura 

Sent: Sunday, April 22, 2007 1 1:25 PM 

To: Jennifer 

Subject: Spring Awakening 

Hi Jen. I had a wonderful day with Emma today. It was 
sunny and warm outside, maybe the first real spring day we've 
had so far. I wore a hat called the Olivia, which was a fabric 
cloche with piped crown and hand-rolled roses in a luscious 
lime green. 

Emma came with me to drop off some dry cleaning, and 
then we went shopping. We went to Eileen Fisher, and bought 
some comfortable pants with an elastic waist in beige and black. 
I also got a button-down sweater that doesn't pull over my head. 
All my clothes have to be easy now. No energy to spend on 
snaps and zippers and buckles. We also got a great jacket for 
Emma from the Petites section. Then we went next door to Le 
Sportsac, and Emma helped me choose a pouch I can use to 
organize all the stuff I carry with me now (Meds, iPod, anti- 
nausea pills, pencils, toothbrush, toothpaste, numbing spray, 
and anesthetic cream). 

After a quick lunch, Emma and I went to see "Spring 
Awakening," a Broadway musical about a young girl's coming 
of age. We've been listening to the CD, but hadn't seen the 
show yet. Emma and I have been seeing musicals together for 



years. I love our excursions. I've always been a big fan of 
musicals, and the boys never want to go; David and Nate both 
believe that people should not spontaneously burst into song. 
It's great to spend time with Emma — she's such a bundle of joy 
and energy. Any experience is more fun if Emma is there to 
share it. 

I remember our first mother-daughter outing to the 
theater more than a decade ago. Emma was three, and I had 
gotten tickets for us to see the ballet at Lincoln Center. All 
around us were mother-daughter couples, including one couple 
next to us with a mom in her 50s and a daughter in her 30s who 
have apparently been coming to Lincoln Center together for 
more than twenty years. Emma was very excited at the 
beginning of the show but when I turned to talk to her as the 
curtain rose at Intermission, I saw she was fast asleep. The most 
expensive nap in history. 

We loved Spring Awakening. There were young actors 
we'd never seen before and the music had a strange 
combination of dissonance and consonance as well as a mix of 
styles including classic show-tune, gospel, and rock. Afterwards, 
I got Emma a Spring Awakening t shirt and the script of the 
play from which the musical was adapted (although the story 
was primarily an excuse for the music). We took a cab home 
and the four of us had dinner together. Nate and David went out 
to a jazz club. Emma and I listened to the music from the show 
and fell asleep before the CD ended. 




From: Laura 

Sent: Monday, April 23, 2007 1 1 :59 AM 

To: Peter 

Subject: Flow cytometry 

Hi Peter. I had a repeat Omaya tap to see if there are still 
lymphoma cells in my CSF. Can you give me a buzz at x7289 
to discuss the results of the flow cytometry? I gather this is the 
critical test. 



From: Laura 

To: Phil 

Sent: Mon Apr 23 12:07 AM 

Subject: Go with the flow 

I talked to Peter about the CSF flow results and he said 
it's negative for lambda or kappa clonal excess. Apparently that 
means there's no lymphoma in the CSF! That's one for the 
home team. 

After Cycle 3, we have to confirm that the cells are clear 
in the LP. I'll set it up. 




From: Laura 

Sent: Monday, April 23, 2007 9:45 PM 

To: Jennifer 

Subject: Good news 

Hi Jen. Thanks for your note. I know how hard it is to 
find a new nanny. I wish I could launch a Philadelphia spin-off 
of our Nanny Resource list-serve for you and find you a perfect 
nanny. I'll ask Carmen if she knows of any nannies in Philly. 

I got some good news today — the flow cytometry on my 
CSF showed no clonal excess! In English, that means that the 
funky lymphocytes in my CSF are probably NOT lymphoma. I 
need to confirm that finding with another lumbar puncture (LP, 
or spinal tap), to make absolutely sure that the CSF is clear, but 
this raises my chances considerably. This result is just what I 
was hoping for, and I'm glad about it, but I can't completely 
rejoice until we confirm the results with an LP, which will 
happen after I finish this round of chemo. 

Yes, I'm being admitted tomorrow for more high-dose 
IV methotrexate. I'll probably go home Sunday. I hope I get 
admitted back to M8. They were so nice to me the last time. 

Have to pack for my admission. My next emails will be 
from the hospital. 


From: Laura 

Sent: Tuesday, April 24, 2007 9:49 PM 



To: Maureen 
Subject: Thank you 

Hi Maureen. Thank you for leading Athena tonight! I 
already hear through the grapevine that you did a fantastic job. 
Can't wait to hear the details. 


From: Laura 

Sent: Wednesday, April 25, 2007 1:21 AM 

To: Gerald 

Subject: Never mind 

Hi Gerald. I'm writing to apologize for the desperate 
middle-of-the-night email I sent you a couple of days ago. I'm 
glad I got your autoreply that you're out of town with limited 
email access. When I sent the email, it looked like my 
lymphoma wasn't responding to the chemo and I got scared. 
Luckily, the news this week was great. My CSF is clear — no 
lymphoma! So we're both off the hook for now. Hopefully, 
when you get back, you'll read both of these emails at the same 
time and know not to worry. 

In this place where we spend most of our lives fighting 
cancer, it's good to have you on our team. I won't be shy to 
write if I need you again. 

Best wishes 



From: Laura 

Sent: Wednesday, April 25, 2007 2:54 AM 

To: Jennifer 

Subject: Second admission 

Hi Jen. I'm sorry you're short of breath. You're so petite, 
the baby occupies a substantial portion of you, and when your 
diaphragm tries to descend to allow the lungs to expand, your 
belly is telling your diaphragm "stay away from me!" Don't 
worry, this too will pass, and soon you will have your beautiful 
baby boy. I can't wait to meet him! 

Yesterday I was re-admitted for more IV methotrexate. 
Wearing my Monk cap, I went up to the 4th floor to see Phil in 
the Clinic. Cindy met me there — I wasn't sure if they were 
going to give me another intrathecal chemo today or not. After I 
had my fingerstick, they called us into the office. Phil told me 
that since my flow cytometry was negative, I don't need to get 
more intrathecal chemo for the time being. HOORAY! He said 
that after the third round of IV chemo I'll get an LP as well as 
repeat MRIs of the spine and brain, and then we'll discuss with 
Sam whether I need more intrathecal chemo at all. 

I went to the Admitting office, and finally I was 
admitted back to M8. It's a different room, but still fine. The 
computer has this weird soft rubber keyboard which takes 
a little getting used to, but the layout is normal 
(QWERTYUIOP etc.). I already had multiple visitors, including 
one who brought me flowers which I'm allowed to have today 
because my white blood cell count is still OK. When your white 
cell count falls after chemo, they don't allow you to have 
flowers because they could be a source of infection. 



The nurse "accessed the port" after I sprayed it, and 
hooked me up to the pump on the IV. The IV pump follows me 
everywhere, beeping whenever it's unplugged. They started the 
bicarbonate drip and gave me the premeds. The methotrexate 
started at 7:30 pm and ran for four hours, so it was done at 
1 1 :30 pm. Now I'm getting more bicarb. I get hydrated all day 
tomorrow, and then I get the leukovorin rescue starting 24 hours 
after the methotrexate began. So far so good. 

Terri is busy editing her movie on "The Physician as 
Patient." She'll present it at the annual meeting of the American 
Society of Clinical Oncology (ASCO) in June. 

I'm getting sleepy. While I go to sleep, I'm going to 
listen to Yo-Yo Ma and Emanuel Ax doing the Brahms E Minor 
Sonata for Cello and Piano that you and I used to play together 
(Allegro non troppo, Allegretto Quasi Menuetto — Trio, and 
Allegro). Usually I'm asleep before the end of the first 


From: Laura 

Sent: Wednesday, April 25, 2007 3:32 PM 

To: Women Faculty 

Subject: Athena lives 

To Our Guests at Athena last night: 

I'm writing to thank you for coming to Athena last night. 
It means so much to me that Athena lives even when I can't be 
there — it means that our group is self-sustaining. I especially 
want to thank Maureen for hosting the meeting while I was 



getting chemo. And I actually did join in the toast you had for 
me — I just did it with methotrexate instead of white wine. I've 
now received 9 of 18 chemos (halfway)! 

I'll beat this. You can't keep a good woman down. 


From: Laura 

Sent: Wednesday, May 2, 2007 6:29 AM 

To: Jennifer 

Subject: Tales from inside the house 

Hi Jen. Sorry for my long silence. I had to focus on 
getting through my admission. But things are good, and I have 
many stories to tell you to catch up! 

First, about the admission. I wrote to you that the high- 
dose methotrexate went fine, and the rest was also pretty 
uneventful, fluids and peeing. They put a plastic container 
euphemistically called a "hat" in the toilet that collects all the 
urine so that it can be measured, and they track my Intake and 
Output (Is and Os). The system is imperfect — they carefully 
monitor every cubic centimeter (cc) of fluid that I get IV, but 
then they ask me how much I drank, and I have no idea, so I just 
make up a number. No matter when they ask how much I've 
had to drink, I look at them confidently and say, "200 cc." 

They take my vital signs (pulse, temperature, blood 
pressure) every six hours. I had a running joke with the nurses' 
aides about the impressiveness of my vital signs. When the team 
came by to round in the morning I told them that I had the best 
vital signs on the floor. Some of the nurses' aides thought it was 
hysterical, and others seemed puzzled by me. Maybe some of 



the M8 patients getting bone marrow transplant who are in the 
hospital for weeks at a time get a little depressed and don't talk 
much to the aides. 

Apparently the fellow on my team heard me brag that I 
had the best vital signs on the floor, and when she presented me 
at lymphoma rounds to the other doctors, she described me (in 
good humor) as a competitive overachiever. A friend of mine 
who is a lymphoma doc and attends lymphoma rounds told me 
what the fellow said. So the next day, when the fellow came to 
see me at rounds, I told her, "I hear that in rounds you called me 
a competitive overachiever... I just hope you realize that if I am 
a competitive overachiever, that I am the best competitive 
overachiever on the floor!" We laughed. 

I had terrific nurses. My day nurse was usually Trish, 
and my night nurse was a wonderful person named (of all 
things) Jen! It's amazing how much the nurses affect your 
hospital experience. The doctors breeze in, glance at your chart, 
ask a couple of questions, listen to your heart and lungs for two 
minutes, and then disappear into doctorland to write notes and 
orders. When you need a Tylenol at 3 am or something hurts, 
it's the nurses who come. I'm amazed at how softly the nurses 
can tiptoe into your room in the wee hours of the morning and 
do what needs to be done without waking you up. 

Guess what — Nate grew up! I never knew that I would 
be able to identify the precise date when he grew up, but it was 
Thursday, April 26, 2007. It was around 7:30 in the morning, 
and David had dropped by to have breakfast with me in the 
hospital. He started coming to have breakfast with me most 
mornings when I was in the hospital, after he got the kids off to 
school. It was our time together. That morning, while David 
was visiting, I called Nate to tell him I was worried because he 
didn't seem to be doing much homework. Over the phone, I told 



him that I was concerned that he would jeopardize what he has 
spent three years in high school trying to achieve. 

Nate calmly explained that he had already spoken to all 
of his teachers. He had discussed every single subject, 
reviewing what assignments he has, which ones he has to do, 
which ones he can skip, which papers he can hand in late, etc. 
Nate said he wanted to be in control of his schoolwork, which 
showed a great deal of insight and self-awareness; he can't 
control my cancer, but he can control his work. He said that 
he hadn't told me because he didn't want to burden me, but that 
he's taking care of his work and he asked that I respect that. 
This was no teenager; he was mature and rational. I hung up the 
phone, turned to David, and said, "He's an adult." 

I had a lot of visitors. It's nice to see people, but 
sometimes it got a little out of control. It's hardest when four 
people who don't know each other come at once. For my next 
admission, I'm going to get a guest book and have people sign 
in and make comments at the door. 

I narrowly dodged a blood transfusion. I was anemic to 
begin with (my hemoglobin was 8 point something; normal is 
12), and then when they hydrated the hell out of me, my 
hemoglobin went down to 7.5 (basically they diluted my 
hemoglobin, a process called "hemodilution"). I had agreed to 
be transfused if it went below 7 but really didn't want a 
transfusion if it wasn't essential. So I claimed I had just become 
a Jehova's witness ("Jehova was just here! I witnessed Him!") 
and talked them into giving me darbopoietin, an injection that 
helps your bone marrow produce more red blood cells. Thank 
God I avoided the transfusion. The more they do to you, the 
greater the chances that something will go wrong — or, as we 
used to say in internship, the more you stay, the more you stay. 
My hemoglobin started to come up, so it worked out OK. 



During this admission, I continued doing laps around the 
nurses' station while listening to my iPod and pushing my IV 
pole. At first I counted the number of laps, but then I started just 
doing an hour every morning, before I shower. Just turn on 
Stevie Wonder (At the Close of a Century, Disc 2) and I'm 
ready to rock and roll. I listen to a lot of classical music in the 
room (this time I especially enjoyed Mozart Violin Sonatas with 
Hilary Hahn and Natalie Zhu), but when I'm walking I go for 
more popular stuff. 

I was discharged before noon on Saturday. David came 
to pick me up with his mom, who was visiting from California. 
We had brunch with the kids at home, toasted bagels and 
unsalted nova and cream cheese and fresh orange juice, one of 
my favorite New York traditions. After she left, I went to pick 
up new prescription glasses and I can see! It's miraculous. 

Re the plan for chemo etc. — I'm getting IV R-CHOP 
again tomorrow. After my next admission, I'll be done with the 
third cycle of chemo and they'll do restaging tests. 


From: Laura 

Sent: Saturday, May 5, 2007 2:56 AM 

To: Jennifer 

Subject: Seeing the light 

Dearest Jen, 



I've reached a new phase in this cancer thing. I've 
already finished 10/18 planned doses of chemo, so I'm past the 
halfway mark. I can see the light at the end of the tunnel. 

I enjoyed my laps around the nurses' station during my 
last admission so much that I decided to try walking on the 
beautiful boardwalk overlooking the East River by my house, 
called John Finley walk, in Carl Schurz Park. I enter the Park at 
88 Street, right next to Gracie Mansion, which is the Mayor's 
mansion (although Bloomberg doesn't live there, because 
apparently his own apartment is even nicer!). When you walk 
on the boardwalk, you can see a majestic view of the river, 
boats, Roosevelt Island, the Triborough Bridge, light, and sky. 
A moderately paced walk from one side of the boardwalk to the 
other takes ten minutes, so you can do three complete laps back 
and forth in one hour. If you're very ambitious, you can go 
down the staircase on one side of the boardwalk and walk 
further downtown as far as the East 60s, and then come back. 

For the past several days, I've been doing this walk for 
an hour each morning, wearing my iPod, listening to different 
music every day (The Supremes, the soundtrack of Wicked, 
Carole King, James Taylor). It's fun! There's a whole culture 
out there in the mornings, with runners, walkers, newspaper- 
readers, bike-riders, stroller-pushers, etc. I particularly love 
seeing the people play with their dogs in a special fenced off- 
area. The dogs hang out on one side and the people on the other, 
like it's a big cocktail party. The other day a man sat on a bench 
reading the paper, and next to him was his large long-legged 
dog. The dog's front legs were on the pavement, but his butt 
and hind legs were up on the bench — he sat on the bench like a 
person! I wish I'd had my digital camera. 

Today I went to my 61 st Street office. I read through 
snail mail, which included more cancer presents, and emails. 
For the book I'm writing, I'm trying to decide whether to 



include just the emails I send, which are mostly to you, or 
whether I should also include emails I get from other people. 
I've gotten some wonderful and supportive emails, and it may 
be nice to include them, because one take-home message I'd 
like to give people is that if you reach out to people, sometimes 
they are there for you in wonderful ways. If I do include other 
people's emails, I'll let the authors of those emails read the book 
and ask their permission to let me use the emails as written. 

Tonight David and I had a date. We went to see 
Cassandra Wilson at the Blue Note. She is a wonderful jazz 
singer who doesn't do a lot of club dates in the States anymore. I 
wore a new black sleeveless dress, a turquoise sweater, pearls, 
and a hat called the Lucy, which is a black weave with a soft 
silk silver bow. The music and dinner were fabulous but we 
were crushed in like sardines. It was the first time David and I 
went out to hear jazz together since his birthday party. I looked 
at David during the music and pictured him at jazz clubs over 
the years, starting when he was a kid in the Bronx and too 
young to get into the clubs so he would listen by the door. 

I figured out how this lymphoma will behave. I'm going 
to go into remission with the chemotherapy, and will transform 
this acute threat on my life into a nice chronic disease for which 
I'll have to take pills and have follow-up tests. Every few years I 
will recur, because that's what lymphomas do. When I recur, 
they'll blast me with chemo, which I'll tolerate remarkably well, 
and I'll go into another remission. As time goes by, they'll do 
more research; the chemo will get better and the remissions will 
be longer. And I could percolate around like this for twenty 
years, or maybe longer, until one day the recurrence will get me 
or I'll be hit by a bus or something entirely different. And 
maybe I'll outlive everybody else, and be looking for someone 
to whom I can send emails at 2 am. Good plan? 



How are you today? Do you feel like the baby will come 
any minute now? When is the actual due date again? 


From: Laura 

Sent: Saturday, May 5, 2007 1:27 PM 

To: Mike 

Subject: Your hat 

Hi Mike. I guess Mel told you about my lymphoma. 
How wonderful that you sent me two hats! I bought 15 hats at 
the beginning of chemo, and since then people have been 
sending me hats as presents (usually baseball caps). Until today, 
I had 28 hats; your hats are #29 and #30. At this rate, I'll be able 
to get through the rest of my chemo and never wear any hat 
more than three times! 

I'm impressed that you wore one of the hats during a 
New Year's Day Alcatraz swim, and the other when you 
finished the Ironman World Championship Triatholon in 
Hawaii. I love the card, "Wear these be victorious." 

Keep those prayers coming. If God hears from a rogue 
like you, he'll know something is up that he has to take 
seriously. Since you're Greek, maybe you should pray to a 
Greek God. Let's get Zeus on board. 

I'm doing great. I'm more than half done with the chemo, 
and I started walking about an hour every day on this gorgeous 
boardwalk by the East River, right next to my house. One of 
these days (after my white cells come back), I may jump in the 
water and become a Polar Bear like you 



I'm writing a book about being a doctor and a patient, 
and it's more than half done. I was going to call it Both Sides 
Now, like the Joni Mitchell song. Unfortunately, there are 
already about a million books with that title. These books 
include, but are not limited to, Both Sides Now: A Twenty-Five 
Year Encounter with Arabs and Israelis, Both Sides Now: The 
Story of School Desegregation 's Graduates, Both Sides Now: 
Living and Dying in San Francisco, and, my personal favorite, 
Both Sides Now: One Man 's Journey through Womanhood. I 
had to come up with another name. I've decided to call it / 
Signed as the Doctor because when they gave me the consent 
forms to sign for those god-awful procedures when treatment 
began, I kept forgetting I'm the patient, so I signed as the 

We're already fantasizing about the post-chemo 
celebration vacation to Turks and Caicos in September. Blue 
sea, white sand, not a care in the world, and I hear I can bump 
into Donna Karan by the pool. But I'll be in the ocean 
snorkeling with fish in the reef. 

Love to Sheila. Keep the faith. 


From: Laura 

Sent: Saturday, May 5, 2007 3:13 PM 

To: Jung-min 

Subject: Hi! And a few things 



Jung-min — are you at the American Roentgen Ray 
Society meeting today? I left you a message on your cell — I 
called for a few reasons: 

1. Good luck! Your presentation will be fabulous. 

2. Can you pick up an abstract book for me? If they give 
you a hard time, tell them it is for a colleague of yours with 
cancer who couldn't come to the meeting. And ask for it early in 
the week — by later in the week, they tend to disappear. 

3. Who is the moderator of the scientific session at 
which you'll be presenting? Before the presentation starts, go 
up to the moderator, introduce yourself, and check out the 
podium. Make sure you know how to advance the slides or go 
back, how the pointer works, and where the timer is so you can 
pace yourself. 

4. I've gotten multiple phone calls about you for 
recommendations for the various programs for which you're 
applying, and I tell them you are fabulous. But promise me you 
won't accept any offers until we talk. I want to give you my best 
advice when you have all the offers on the table. 

You can call me back on my cell, email me, or call me at 
home. Which day is your talk, and when are you coming back? 
Are you staying at the meeting hotel? Are the accommodations 
OK? Do you know anyone at the meeting? 

It is a beautiful day in New York today. I hope your trip 
was gentle and that you are having a wonderful time. Enjoy! 


From: Laura 

Sent: Tuesday, May 8, 2007 4:10 AM 



To: Jennifer 
Subject: Baby? 

Dearest Jen, 

How are YOU? What is the status of Baby Boy Menell? 
When I didn't hear from you I thought you had the baby — 
what's going on? Can you email me your cell phone, home 
phone, and work phone numbers again? In my prednisone 
craze I can't find them. Otherwise, I'm doing great and will 
resume writing to you more regularly soon. 

David and I saw the play "Inherit the Wind" on 
Broadway, and it was fantastic. It's funny how a play about 
evolution vs. creationism can be so relevant to current times. I'd 
been excited to see Brian Dennehy, but I was really blown away 
by Christopher Plummer. They were both amazing. 

I miss you and love you very much, and wish you every 
joy in your new son, whenever he decides to make his debut. 


From: Laura 

Sent: Saturday, May 19, 2007 10:44 AM 

To: Jennifer 

Subject: Third admission 

Dearest Jen, 

It's been awhile since I wrote you a good long letter, so 
here it comes. I'm an inpatient now, finishing up Cycle 3 of 
chemo with the high-dose IV methotrexate and leucovorin 
rescue. The chemo went fine on Thursday — no problems. I got 



admitted a little earlier than usual, so they started the chemo 
earlier, which made the schedule flow a little more smoothly. 

I've been feeling good, in spite of my ongoing worn* 
about the LP I'll have when this cycle of chemo is over. I'm 
walking laps around the nurses' station again with the iPod. but 
I miss the boardwalk. I had so many visitors during my last 
admission that this time I brought a guest book — vou know, like 
they have at a country inn or someone's wedding? The guest 
book had a soft green cover and cream-colored paper, and I had 
bought it at Kate's Paperie. I invite my guests to sign in and 
make comments. I considered having a cover charge and a two- 
drink minimum, but apparently that violates hospital regulations. 

Today I had tickets for Emma and me to see A Chorus 
Line that I had bought months ago. but since I'm still in the 
hospital. Emma invited a friend to go with her. It will be her 
first Broadway show without me. I hope they have fun. 

So when is this baby going to appear? Keep me posted! 


From: Liberman, Laura/Radiology 
Sent: Wednesday. May 23. 2007 1:27 PM 
To: Jennifer 
Subject: LP results 

Hi Jen. I had my LP (lumbar puncture, or spinal tap) 
yesterday. The procedure is done by a neuroradiologist under 
fluoroscopy ("fluoro"), x-ray equipment that gives 
instantaneous images of your bones and other structures. You 
lie face down on a table, and then the table tilts so that vour 



head is up and your feet are down, at an angle. The radiologist 
uses the fluoro to figure out exactly where to put the needle, 
usually between the 3 rd and 4th of the five lumbar vertebrae (the 
back bones in the lower spine). My wonderful friend Hilda did 
the LP, and Sam came in person to deliver the fluid to the lab. 

Today they got the results. There were only two white 
blood cells, down from 76, with no clonal excess — meaning no 
evidence of lymphoma! With the negative LP and the negative 
Omaya tap, we can say that the CSF is clear. I wish I could play 
the music from "I Will Survive," but that will make me feel like 
dancing, and I'm supposed to lie flat for several hours after the 
LP (I shouldn't even be sitting at the computer to write you this 
note, but I can't resist). I bought the DVD of "Dreamgirls," and 
Carmen and I are going to watch it together. 

The baby is due any day now, right? You must be so 
excited. You'll finally get to meet your son! 



Chapter 12 
More Birthdays 

Savor celebrations. 

From: Laura 

Sent: Sunday, May 27, 2007 1 1:56 PM 

To: Jennifer 

Subject: Emma's birthday 

Hi Jen. Today was Emma's 15 birthday. Since her 
birthday falls on Memorial Day weekend this year, we're 
having the party for her friends next week, but today we had the 
family celebration. 

In the morning, we showered her with gifts — books and 
DVDs that we thought she'd like, as well as camera equipment 
(she has a passion for photography). We let her pick what meal 
she'd like to go out for, and what restaurant. She wanted me to 
take her to lunch at Candle 79, our favorite Vegan restaurant in 
the city. Then we went shopping together at her favorite 
stores — Urban Outfitters, American Apparel, H&M. 

In the evening, we turned out the lights, gave her a cake 
with 16 candles, one of which was for good luck, and sang 
"Happy Birthday." I bought her the cake at Greenberg's, one of 
the best bakeries on the East Side of Manhattan, where I've 
been getting the kids their birthday cakes every year since they 
were old enough to eat chocolate. Emma's cake this year was 
pure chocolate — chocolate cake with chocolate frosting, and 
said "Happy Birthday Emma" in yellow icing on top. 

As I watched Emma and Nate while we sang happy 
birthday, I thought about how different they are from each other. 



Nate has always been cautious; he looks so much before he 
leaps that sometimes he doesn't get around to the leaping part. 
Emma, on the other hand, is absolutely fearless. When Nate and 
I used to cross the street when he was young, he would hold my 
hand, and ask, "Is it OK, Mom?" If Emma saw something 
interesting on the other side of the street, she would have 
dashed across if I hadn't been holding her hand tightly. Since 
Nate is older and more cautious, he always looks out for his 
sister, and has since she was a baby and tried to put seashells 
into her mouth at the beach. 

Emma is the most extroverted member of our family. 
When she was two and a half, we signed her up for a program 
called Discovery that was held for about three hours twice a 
week. On the first day, the other kids all had trouble separating. 
Emma looked in the room, saw that there were art supplies, and 
said "Bye, Mom!" She has always been like a Pied Piper for 
other kids — when she went to the park, all of the other kids 
wanted to play with Emma. She has a way of relating to kids of 
any age — whether they are younger, older, or the same age, she 
manages to find common ground. 

Emma's birthday today made me think back to her other 
birthdays, like the one when she was in third grade. I had taken 
a vacation day from work so that we could celebrate after 
school. She had the mildest case of pink-eye that day, so the 
school nurse wanted to send her home. Emma was initially sad 
to be kicked out of school on her birthday, but when I picked 
her up, I told her, "Emma, don't worry. We'll shop 'till we 
drop!" As it turned out, after about three stores she was still 
bursting with energy but I was exhausted. She gleefully told me, 
"We shopped until YOU dropped, Mommy!" 

I can't believe that Emma will be going to sleepaway 
camp in a few weeks. I'll miss her. She's like a bundle of 
sunshine — it's impossible to be sad around Emma. When she 



goes, there is this big hole that's impossible to fill. But she loves 
camp, and at least they cut it down from eight weeks to six. The 
first time Emma went to sleepaway camp, a woman in my 
building asked me how I was doing. I said, "My daughter just 
went to sleepaway camp for the first time, and I miss her." The 
woman said to me authoritatively, "When my son went to 
college, I cried for two weeks. Then, I moved into his closets!" 
She was saying that in New York, it's OK when a child leaves, 
because look how much you gain in closet space! 

How are you doing? Do you think the baby will come 
today? Then he and Emma would have the same birthday! 


From: Laura 

Sent: Wednesday, May 30, 2007 5:49 AM 

To: Jennifer 

Subject: Great news 

Dearest Jen, 

Congratulations on Benjamin Matthew! You've used 
two of my favorite boys' names in the whole world. I love the 
name Benjamin, whether it's Ben or Benny. Like Nate, he'll 
probably declare himself as one or the other. 

How did Sophie react when you brought home her new 
brother? I'll never forget bringing Emma home from the 
hospital. Nate greeted her at the door with a photo album and 
called her "Baby." He showed her pictures of the people in our 
family and tried to teach her their names. He also showed her 
pictures from a trip to the zoo, and explained, "Look, Baby, 



here's a peacock!" Emma couldn't even hold her head up, much 
less scrutinize the photographs. But Nate was undeterred. At 
dinner that night, he offered Emma a forkful of his food and 
asked, "Baby, want some steak?" I had to explain that Emma 
was too young to eat steak, that so far all she could handle was 
milk, and that we would have to teach her lots of things. 

I got some great news this week. After I finished the 
third cycle of chemo, they repeated the spine MRI and the CT 
scan, and they were negative! The spine MRI showed that the 3 
cm tumor that I used to have in my upper spinal cord is GONE, 
and the CT showed that the lymph nodes are smaller. So chemo 
works! I don't need any more intrathecal chemo injected into 
my head, but I need three more months of IV chemo. 

I thought I was supposed to get R-CHOP yesterday but 
apparently I'm getting it Thursday. That changes my chemo 
schedule in a way that means I get to be home on our 25th 
wedding anniversary. David and I are going to have a little 
ceremony where we renew our vows on our terrace, either that 
day or on the weekend after I'm discharged. It's not going to be 
fancy — just the four of us, and maybe some close family friends. 

The vows we're going to read are from a list of promises 
we wrote to each other when I followed David to New York for 
medical school. It was so long ago we didn't even have a word 
processor — we typed it on our old Smith-Corona typewriter. I 
looked at it today for the first time in years. The paper is 
yellowed and crinkly, and there's a typo with a hand-written 
correction. The promises were pretty astute, though, especially 
considering that we were kids — eg "We won't let our 
perceptions of each other's parents blur our perceptions of each 
other" and "We won't let each other be lonely." And then 
there's one that is unoriginal but still one of my favorites: "We 
will take care of each other in sickness and in health." I'm 
thinking, damn, I'm glad we put that in! 



Have fun with the new baby. It's an amazing time. And 
take advantage of any opportunity to spend time with Sophie, 
who was just "dethroned" by her new sibling — it'll mean the 
world to both of you. 


From: Laura 

Sent: Saturday, June 2, 2007 4:04 AM 

To: Jennifer 

Subject: The Prednisone Diaries, Revisited 

Dearest Jen, 

And here we go again — back on Prednisone! At least I 
can count on writing in the wee hours of the morning for five 
days a month. I'm in the midst of Cycle 4 out of 6 cycles of IV 
R-CHOP. I can't believe I have only 4 more chemos left (2 IV 
RCHOPS and 2 high-dose IV methotrexates). 

We're busy making preparations for Emma's 15 th 
birthday party, which will be on our roof tomorrow night. Since 
her birthday at the end of May usually falls on Memorial Day 
weekend, we generally have her party in early June. 

Please let me know how the bris went, and keep me 
posted about Benjamin and Sophie and Jim and nursing and 
sleeping (or lack thereof) and everything else in your life that 
you want to share. 

Much love always 



From: Laura 

Sent: Monday, June 4, 2007 3:29 AM 

To: Jennifer 


Subject: Emma's 15 birthday party 

Hi Jen. Last night was Emma's 15 th birthday party with 
her friends. We had it on the roof of our building, so we could 
use the rooftop swimming pool, surrounding terrace with 
lounge chairs, other outside areas, and the room with the ping- 
pong table. I had heard that there was going to be a 
thunderstorm, in which case they would have either stayed in 
the ping pong room or gone downstairs to another party room in 
our building. Luckily, though, the weather held out, and they 
stayed on the roof. 

Emma wanted to keep it simple — pizza, chips, soda, 
brownies — music from the iPoD — dancing — ping pong — 
swimming. Even with that plan, there was a lot to prepare. We 
got the food and the drinks (sodas and water), paper plates, and 
plastic utensils. We cut up carrots and celery for appetizers and 
Emma made a delicious dip (she is truly a fabulous cook). 
Emma made a playlist of the music she wanted to play. Three 
friends came early to help set up. 

The party was a big success. One guy had forgotten to 
bring his bathing suit, and Nate generously went up to the roof 
to lend him one of his prior bathing suits, which fit the guy 
perfectly. We provided towels for everyone who wanted to 
swim. When you have parties by the pool in our building, you 
are obliged to use a lifeguard from the service that generally 
works at the pool, so the lifeguard was there. The party was 
from 7-11 pm. Since it's already starting to stay light a little 
later, there was about an hour and a half of light before it got 



dark, and then they turned on the lights upstairs, which made 
the pool glow an inviting turquoise blue. 

After the party, David, Emma, and I cleaned up. There 
were a few dishes to wash, and we had to throw away a lot of 
used paper goods. Emma was happy, bubbling over with 
excitement about the night. She had a stack of presents but 
decided that she'd open them in the morning. 

Once when I was quizzing Nate on Spanish vocabulary 
to prepare for a test, we came across the word "Quincenara," 
which is the celebration for a girl's 15* birthday. I guess the 
Latina tradition is to celebrate sweet 15 instead of sweet 16. 
Emma had a wonderful Quincenara. 


From: Junior Faculty Council (JFC) 
Sent: Wednesday, June 13, 2007 10:39 AM 
To: Faculty Nominated for Mentoring Award 
Subject: MH 2007 Mentoring Award Nomination 

Dear Colleagues, 

We recently announced a new Memorial Hospital 
Award for Excellence in Mentoring . On behalf of the Junior 
Faculty Council, we are pleased to inform you that you have 
been nominated by a Junior Faculty member as an Outstanding 

We received many outstanding nominations and we 
thank you all for your contributions to mentoring. The recipient 
of this award for 2007 will be announced at the JFC Town 
Meeting, Tuesday, June 19th in room M-107, 12:30. 



We hope that you can join us in celebrating this 
important achievement. 


From: Laura 

Sent: Saturday, June 16, 2007 10:15 AM 

To: Jennifer 

Subject: Wedding anniversary 

Dearest Jen, 

When I read your note about how tough it can be with 
the second baby, I remember back to when Emma was born. It 
is much harder after the second than the first, because there are 
two tugging at your energy and attention. That was when I 
considered going part-time, and almost did it. It wasn't until 
Emma was about six months old that I felt I was kind of hitting 
my stride again a little bit. It's good that you had a baby nurse 
for awhile. How is the nanny doing? Are you getting to spend 
any time with just Sophie? 

Time is going by so quickly now. Wednesday was our 
25th wedding anniversary. We renewed our vows on the terrace 
with the kids. It was just the four of us because the Berkowitzes 
couldn't come. I wore a white lace shirt, a colorful print skirt, 
and a white hat, and David wore a suit. We alternated back and 
forth reading our promises to each other, with the sweeping East 
River and the Tri-Borough Bridge as the backdrop. Then we 
gave each other gifts. David got me a new ring, with a plain 
gold band sprinkled with tiny diamonds. I loved it because it 
seemed to be a perfect metaphor for our marriage: multiple tiny 



sparkling moments that add up to a lifetime of being together. I 
gave him an engraved watch. Afterwards, we asked the kids 
what they wanted for dinner and ordered out for Thai food. 
That's a 25-year marriage. 

On Thursday, I was admitted to the hospital for my 
second-to-last round of inpatient chemo. Everything moved 
slowly that day. I had a 9 am appointment with Phil. I was very 
anemic and he wanted to give me a shot of darbopoeiten, but 
that had to be ordered from the pharmacy, so I waited until 1 1 
am. Then I went to Admitting, but I had left my hospital card at 
Phil's office, so I had to go back and get it, and while I was 
there they wanted to change an appointment, which took time. I 
got back to Admitting at almost 12, and it was afternoon by the 
time I got to M8. Then they had to do a blood test for 
electrolytes and wait for the results; it took forever to start the 
bicarb drip. 

I usually need to be on the drip about 4 hours to 
alkalinize my urine pH above 7.5. Only after the urine pH is 
high enough do they order the methotrexate, which then has to 
be mixed and delivered from Pharmacy. I didn't start the 
methotrexate until 8 pm, and it's a 4-hour infusion. Once I get 
the methotrexate, then 24 hours later I get leucovorin "rescue," 
and continue to get leucovorin every 6 hours as long as I'm here. 
So it means that my schedule for the leucovorin is 8-2-8-2 
(which means I have to get up for vital signs at midnight and 
then they hang the leucovorin at 2 am). The first night I only 
slept about two hours, but I got a little nap on Friday, so I was 

David came in the morning on Friday and we had 
breakfast together, which was nice. Lots of visitors on Friday, 
including Cindy and our wonderful technologists with whom 
I've become very close over the years — Youngduk, Indira, 
Anita, and Joanna — and they came with frozen yogurt! I 



brought my guest book back with me this time and most of my 
visitors signed it and wrote in it, like they did during my 
previous admission. 

Emma came by herself later in the day and did my nails 
in a beautiful sparkling white. Nate joined her, and then David 
came. We all hung out together until they went home around 
8:45, and I went to bed. Slept until 4 am, woke up drenched (I 
have night sweats), got up and showered and changed, and then 
felt so awake I walked my laps around the nurses' station. Then 
I came back to my room and napped about two hours, until 8 
o'clock when Kathy, my nurse, came in to hang the 8 am 
leucovorin and give me my morning meds. 

They've decided I need a total of 16 chemos, not 18 as 
they originally thought, and I've had 13 out of those 16 chemos 
already. If everything goes according to plan, I need three more 
chemos after this: two outpatient IV R-CHOPS and one more 
admission for IV methotrexate. My last chemo will be at the 
end of July, less than two months from now. In August, I'll 
have another re-staging work-up, including an MRI and a bone 
marrow. I'm trying to figure out how I'll compose my life when 
the dust settles. I need a kinder, gentler life. 

With this illness, my priorities became crystal clear. I 
don't want to lose that clarity even if the death threat is gone. 
Any guilt I used to feel about doing what I want to do instead of 
what I "should" do has vanished; I've paid my dues many times 
over. I want to spend more time with David and the kids, and I 
don't want to waste time and energy on stuff that is less 
meaningful. I hope I can keep my eye on the ball. 




From: Junior Faculty Council (JFC) 

Sent: Tuesday, June 19, 2007 2:07 PM 

To: Faculty 

Subject: 2007 Award for Excellence in Mentoring 

1st Annual Memorial Hospital Award for Excellence in 


This award was established to recognize outstanding 

commitment to mentoring and will be given annually to a 

Memorial Hospital faculty member nominated and selected by 

the Junior Faculty. We received many outstanding nominations 

and congratulate all who were nominated. 

This year's recipient is: 
Laura Liberman, M.D. 

Attending Radiologist, Breast Imaging 

Director, Breast Imaging Research Programs 

Director, Program for Women Faculty Affairs 

Memorial Sloan-Kettering Cancer Center 

Member, Memorial Hospital 

Professor of Radiology 

Weill Medical College of Cornell University 

Congratulations, Laura! Thanks to all the Junior Faculty who 
shared their experiences. 




From: Laura 

Sent: Thursday, June 21, 2007 5:46 PM 

To: Jennifer 

Subject: Anniversary presents 

Dearest Jen, 

Thanks for your thoughtful anniversary gifts. The books 
are wonderful, and I didn't own any of them! I brought them 
with me to the hospital, but my mom finished writing her 
autobiography and sent me the manuscript, so I read that instead. 
It's called My Life into Art, and is about her development as an 
artist. My mom grew up in Israel and her brother and first 
boyfriend were killed in Israeli wars; her father died young of a 
heart attack. She has had too much loss in her life. I knew some 
of the stories but didn't know all the details. I think I understand 
her better. Did I tell you that she's been emailing me a Blue 
Mountain card every day since I told her that I have cancer? It 
makes me smile when I click on the link and the background 
music starts blaring out of the computer. 

Emma is packing to go to sleepaway camp — she leaves 
June 30, a week from Saturday. I miss her so much when she's 
away. But she loves camp, and six weeks will go by pretty fast. 
Both kids have survived their exams and they are finally free. 
By the end, we were all exhausted. We may have limped to the 
finish line, but we got there. 

The Junior Faculty at my hospital started an award for 
Mentor of the Year. There were 1 5 doctors and/or scientists 
nominated, and I won! They announced it at a seminar on 
Tuesday. I was so touched that I was actually speechless, which 
(as you know) is not my natural state. They gave me a plaque 



that says Mentor of the Year with my name. They forgot to 
engrave the year, and they wanted me to give them the plaque 
back so they could put the year on it, but I like it better this 
way — now every year I can look at it and think I'm still the 
Mentor of the Year. 

David and I went out to hear music last night at the Blue 
Note, a jazz club — McCoy Tyner on piano, his trio, and Toots 
Thielmanns playing jazz harmonica. Toots is about 88 and 
hasn't been healthy, but he sure can play. It's amazing to hear 
those sounds coming out of a harmonica. I spent too many years 
being in the office for too many hours a day. I want to spend 
more time with my family now, and take walks by the river, and 
listen to music, and read, and write. 

I have more I'd tell you but there is a reception for 
medical students who are participating in a summer NIH 
program and I want to do my part to welcome them. I'm 
wearing a special hat for the occasion called the Ruby, which 
has a beige crown, medium brim, and off-white silk organza 
roses and bows. 

Please keep in touch. I love to hear from you. 

Love always 

From: Laura 

Sent: Saturday, June 23, 2007 6:57 PM 

To: Jennifer 

Subject: Grace 



Hi Jen. Today I went to visit a friend of mine in the 
hospital. Her name is Grace, and she works in the Radiology 
Department at Memorial, scheduling general radiology exams. 
I've known her for years. She's a quiet person in her 40s, very 
thoughtful and spiritual. 

I found out that a couple of weeks ago, she showed up 
for work as usual around 7 am, and in the middle of taking a 
phone call she collapsed and became unresponsive. It looked 
like she was having some disaster in her brain. They took her to 
New York Hospital right across the street (we're connected by a 
tunnel), where she was immediately admitted. They did a bunch 
of tests, and apparently she had a stroke. She's been in the 
Neuro Intensive Care Unit ten days now. 

When I was strolling this morning, after I walked south 
on the boardwalk, I went down a flight of stairs and kept 
walking south until I got to the exit at 71 st Street, and then I 
went over a little walking bridge to get back to the street. The 
entrance to New York Hospital is on 70 th Street between York 
and the River. I showed the people at the NYH information 
desk my Memorial ID, and was given permission to go up to the 
Neuro ICU. When I got to the ICU, I was surprised at how 
young all the doctors looked, and then I remembered that it's 
July, the time of year when the experienced doctors-in-training 
leave and new ones start. 

I found Grace. She was in her own "room," really more 
a cubicle with a curtain separating it from the other cubicles. 
She was lying in bed. Her entire body was massively swollen, 
probably due to having received lots of IV fluid to stabilize her 
when she was admitted. She had tubes and lines everywhere — a 
nasogastric tube going through her nose into her stomach, an 
intravenous line in each arm to deliver fluids and medications, 
an arterial line in her wrist to check the oxygenation of her 



blood, and a catheter in her bladder to collect her urine. She 
couldn't move her body on the left side. 

I leaned over so that I was in her field of view. She 
couldn't speak, but her eyes seemed to smile with recognition. 
One of the new young doctors came in, accompanied by an 
older doctor — the new intern, supervised by his more 
experienced resident. They said they were going to have to put 
another tube in her called a Swan Ganz catheter (also known as 
a "Swan") that they insert into a vein in the neck and thread into 
the heart to monitor the pressures at different levels in the 
circulation. They asked me to leave but I told them that I've 
been a doctor at Memorial for 1 7 years and that I have done and 
watched countless procedures. They let me stay. 

I tried to imagine what it felt like to be Grace at that 
moment. She could see what was going on around her and 
recognize people but was unable to talk, and nobody explained 
what they were doing and why. I took her right hand, which she 
was still able to move, and softly told her what had happened. 
"You had a stroke, Grace," I said. "You're at New York 
Hospital in the Intensive Care Unit, and you've been here for 10 
days. They have all these tubes in to give you nutrition and 
medicine. You can't move your left side because of the stroke. 
Often there are things you can't do right after a stroke, because 
the stroke damages brain cells. After you're stable, you're going 
to have rehabilitation and physical therapy so that you get back 
as much as possible." 

She seemed to nod with her eyes, although she couldn't 
move her head. 

The intern started to clean her skin and put a sterile 
drape over her neck in preparation for the Swan. I could feel her 
fear. I explained, "Now they're putting in another tube so they 
can monitor the pressures in your heart." I had my iPod, which I 
always bring when I take my walks. I put one of the earpieces in 



her ear and played a song from the musical Spring Awakening 
called "I Believe." It sounds like a gospel song, and the lyrics 
keep repeating, "I believe there is love in heaven. I believe all 
will be forgiven." When the song ended, I just played it again, a 
continuous loop of faith. 

Grace's right hand, which had been tense in mine, 
relaxed. By the time the intern had finished inserting the Swan 
and putting the final stitches into the skin, Grace's breathing 
was rhythmic and steady, and I saw that she was asleep. She 
must have been exhausted. I let go of her hand, kissed her on 
the cheek, whispered "God bless you," and left. My friend Hilda 
has suggested to me and other friends of Grace that together we 
should get Grace her own iPod, which is a wonderful idea. 
Grace has a daughter who is computer-savvy and can put music 
on it for her. I thought about Grace and the iPod as I walked 
north along the East River, up the stairs, on the boardwalk, and 
then home. 

You know how sometimes when someone is sick, you 
want to comfort them, but you don't how to help? That's how I 
felt when my father had his worst stroke, but it wasn't the case 
today. When I saw Grace, I was certain about what to do and 
how to do it. Cancer has given me that. 


From: Laura 

Sent: Sunday, June 24, 2007 8:54 PM 

To: Jennifer 

Subject: Tea with Emma 



Hi Jen. Today Emma and I went out for tea. We've had 
a tradition of going out for tea together for several years now. A 
few years ago, we got a book called The New York Book of Tea, 
which lists places in New York City "to have tea and buy 
teaware." We looked in the book, marked the places that 
interested us, and systematically explored them. Emma 
especially loves Earl Grey tea, and we're both fond of those tiny 
tea sandwiches, especially the ones with cucumber and 
watercress. And going to tea gives us a chance to talk. 

We've tried a lot of tea places together. The Lobby 
Lounge at the Stanhope Hotel has Limoges china, with delicate 
designs of birds and flowers. The Mayfair Regent has a fruit 
snack with mixed berries. And the Gallery at the Carlyle, 
probably our favorite, has soft lighting and plush couches, and 
they serve "high tea" on a large silver multi-level platter, with 
three tiers: tiny sandwiches on the bottom, scones in the middle, 
and desserts on top. Next to the tea place inside the Carlyle is 
Bemelmans bar, which features walls hand-painted by the guy 
who illustrated the Madeleine books. 

Today we went to the Gallery at the Carlyle. I wore a hat 
called the Erica, which has a square forest green crown, 
medium up-tilting brim, and a trim of lavender silk binding and 
roses. We asked for the high tea, with two orders of tiny tea 
sandwiches and no desserts. We tried a new kind of lemon tea 
which was tart and fragrant. We brought the Sunday paper and 
looked at the theater section to see what other musicals are in 
town. I want to get us tickets for some shows that we can see 
together after Emma gets back from camp. If we have the 
tickets, maybe the time she's away will go by faster. 



Chapter 13 
Chemo Ends 


From: Laura 

Sent: Saturday, June 30, 2007 2:15 PM 

To: Jennifer 

Subject: Emma went to camp 

Hi Jen. Today we took Emma to the bus to go to her 
sleepaway camp, which is called Mountainview in upstate New 
York. When she was younger, and went to day camp, they had a 
one-week optional trip to Mountainview, and she loved it. She 
started going there the summer after that; this will be her fourth 
summer there. 

The bus leaves from 5 th Avenue on the Upper East Side. 
Because they're only allowed to bring two small bags on the 
bus, we have to ship most of her stuff in advance. It's funny — 
there's a weekend in early June where every kid in the building 
seems to be sending their bags to camp — the lobby is littered 
with duffel bags, suitcases, and trunks, ready for pick-up by the 
various camp trucking services. So we had sent most of Emma's 
things already, but there were still a few items she packed at the 
last minute. 

Dropping her off is always bittersweet. She loves her 
camp friends and has always had a terrific time at camp, but it's 
hard to say goodbye, especially since they don't allow the kids 
to have cell phones or Internet access. We can email her letters, 
and the camp prints them out and delivers them to the kids 



during "mail time," which is every day after lunch. We're 
allowed two phone calls and one visit. 

We always have to get to the bus about an hour early, to 
help her load up her luggage and to touch base with her 
counselors. It's great to see how happy Emma is to reunite with 
her friends, and how delighted they are to see her. After the 
luggage is loaded and the kids take their seats, everybody waves 
and the bus takes off. I'll write to her. And by the time she gets 
home, my chemo will be done. 


From: Laura 

Sent: Sunday, July 1 2007 10:00 AM 

To: Emma 

Subject: Camp 

Dearest Emma, 

It's Sunday morning at 9:30 am. I can't believe you've 
only been gone one day! It feels like longer. We got the "safe 
arrival" phone call from camp late yesterday afternoon, so I 
know you're OK. Did you have your swim test? If so, what was 
the effect of the chlorine on your beautiful washed and blown- 
dry hair? 

The rest of the day after dropping you off was 
uneventful. Dad took me home and then he went to work. I 
went out to drop off clothes at the dry cleaners and then to the 
Vinegar Factory to get some fruit — we were out of plums. I 
came home and tried to nap, but couldn't. After a couple of 
hours, Dad came home and fell asleep on the couch in the living 



room, reading. Nate went out and I went up to the pool around 5 
pm. I swam laps for 40 minutes and then came downstairs. Dad 
had already woken up. I took a shower and got dressed for 
dinner — the sleeveless black dress with a silver sparkly jacket 
from Eileen Fisher that I haven't worn yet, with my favorite hat 
(the Butterfly — mauve crown with muted gold silk bow). We 
took a cab and picked up the Sterns to go out to dinner. 

The restaurant we went to was one we'd been to before, 
called Knickerbockers. The food was delicious. I had sole and 
Dad had a T-bone steak, and they had the best onion rings I had 
ever tasted. Dad, John, and Hannah shared a chocolate souffle 
for dessert. Hannah was wearing the elegant gold jacket that 
was part of the suit she wore at Sarah's graduation, with jeans. 
It was a great combination. We had fun with them. Sarah 
already left for camp; Lisa is still around, but will be going to 
softball camp for a week and then to be a counselor at her old 
camp for about a month. After dinner, a trio played jazz; the 
pianist is someone John and Hannah know, who played at both 
girls' Bat Mitzvahs. 

I'm going to take it easy today. I'll take a walk and go to 
the pool to cool off. I'll read in the air conditioning, and then 
maybe do one of my favorite things — napping! 

I love you very much, Emma. I can't wait to hear about 
camp, your bunkmates, your counselors, and what you're doing. 
Where is your bed? Did you set it up with the soft blanket and 

Much love 
Sun Moon Stars 



From: Laura 

Sent: Tuesday, July 3, 2007 6:1 1 am 

To: Emma 

Subject: This and that 

Dearest Emma, 

On Sunday, I hung around most of the day, working on 
the computer and reading the paper. Then in the afternoon I 
went for a walk by the river, and then a swim. Since Sunday 
was July 1 , the pool is now open until 8 every night, and 9 on 
Wednesdays. When I came back to the apartment, Dad had been 
giving Nate a cooking lesson. They covered some important 
ground — meat and potatoes. Dad showed Nate how to make a 
steak, which came out delicious, but Nate said really Dad made 
it. The good news is, no matter what becomes of Nate's cooking 
skills, he will always be able to order out. 

Yesterday was a good day at work. It was quiet — when 
July 4 falls on Wednesday, some people take off Monday & 
Tuesday, and others take off Thursday & Friday, so it ends up 
being quiet for the whole week. I'm off tomorrow for the 4 th of 
July. We'll probably sleep late and go to the pool. 

I hope you're having a fantastic time at camp. I can't 
wait to hear the stories. I love you always. 


Sun Moon Stars 




From: Laura 

Sent: Wednesday, July 4, 2007 1 1:02 AM 

To: Emma 

Subject: 4 th of July 

Dearest Emma, 

Happy 4 th of July! 

Today looks light for all of us. No work, and Nate is still 
sleeping. Dad is writing to you now on his laptop. We may go 
see the Michael Moore movie "Sicko" later. They had a sign up 
in the elevator for the fireworks on the roof, which was odd 
because with the new building next door you can't really see the 
fireworks anymore. It's gray today but not raining yet, so I may 

Emma, I only have 22 days (less than a month!) left 
before July 26, which is the date of my last chemo. I am so 
excited — I want to buy a big bunch of pink balloons and release 
them when it's all finished. 

Have a wonderful day today and every day at camp. 

Love always 
Sun Moon Stars 

From: Laura 

Sent: Sunday, July 8, 2007 6:14 AM 

To: Emma 

Subject: New Jersey 



Dearest Emma, 

Today is Sunday. The boys are still sleeping, but I'm 

Yesterday I had fun! My friend Cindy invited me and 
two friends of ours who we work with to her house in New 
Jersey. We met at 10:30 am at the Time Warner Building, and 
drove to New Jersey. We had each brought flowers. There was 
almost no traffic, so it only took about 20 minutes to drive there. 

The house, which is in Fort Lee, NJ, has three floors. 
The lowest floor is this huge beautiful open common space, 
with a kitchen that has tiles like ours, and a family room that 
has a dining area. Then, on the second floor, there's a sitting 
room, formal dining room, and 2 nd kitchen. The third floor has 
three bedrooms and an office. There is a front yard and a 
gorgeous back area with an in-ground pool, table and chairs, 
and a fabulous garden, and it's all surrounded by tall trees, so it 
was nice and cool and shady even though it was hot outside. 
The house is nicer than any place we've ever rented in Hilton 
Head! I asked Cindy if we could spend our vacations at her 
house. She laughed. 

They had made such delicious food. Cindy's significant 
other, Juan, made the most spectacular guacamole I have ever 
tasted, right in front of us. He explained what he was doing as 
he went along. It reminded me of the TV show where all these 
chefs audition to see who gets his/her own Food Network 
Show — Juan would have won, hands down! They also grilled 
chicken and made this delicious salad with orzo and vegetables. 
I felt like we were eating all day! 

After lunch, we all jumped in the pool. We floated 
around and talked. That's where I was when you called — I am 
so sorry that I missed your call! But I hear from Dad and Nate 
that you're doing great. After 5 we came back to the city. 



My friend Hilda gave me a terrific DVD called Mad Hot 
Ballroom, which is a documentary about a bunch of New York 
City public high school kids who learned ballroom dancing and 
participated in a dance competition. Dad and I watched it last 
night after I got home. You would love it — when you get home, 
we'll watch it together. 

I'm getting admitted to the hospital on Thursday of next 
week, which will hopefully be my last admission, and should be 
home by Monday. Dad will come to Visitors' Day this Saturday 
without me because I'll still be in the hospital. We got 
permission for both of us to come back to visit you at camp on 
Sunday 7/22. 

How'd you get to be so beautiful? 


Sun Moon Stars 


From: Laura 

Sent: Thursday, July 12, 2007 3:38 PM 

To: Emma 

Subject: Last admission 

Dearest Emma, 

I just got to the hospital for my last admission! I have 
the same room that I had the first time I was admitted. When I 
logged onto AOL, your login came up — you must have been the 
last one to use it. This is the room that has the bulletin board 
where you arranged the pins to spell your name, remember? The 
pins are still there, and they still say "Emma." I love those signs 



of you; they make me feel like you're here with me. I'm getting 
a late start on chemo today, so I'll probably go home Monday. 

It's been incredibly hot for the last two days. Tuesday in 
particular was unbelievable. They had a picnic for lunch at my 
work but it was too hot for me to go! Today is a little cooler 
(finally). It rained last night, and I think that broke the heat. 

This morning I took my walk on the boardwalk, and I 
went to the Vinegar Factory to get fruit for this admission. I got 
plums and cherries and nectarines and pluots and grapes. That 
should do for a few days. Dad will bring them when he brings 
my clothes later. And, of course, frozen yogurt. 

There is a pile of bags in the hall of the stuff Dad is 
going to bring you to camp on Visitors' Day this Saturday. You 
guys will have a wonderful time. I love you so much. 

Much love 
Sun Moon Stars 

From: Laura 

Sent: Thursday, July 12, 2007 2:41 PM 

To: Cindy 

Subject: Balloons 

Hi Cindy. Can you remind me where you got the 
beautiful bouquet of pink balloons that you gave me for my 
birthday? I want to order some. Thanks! 




From: Laura 

Sent: Sunday, July 15, 2007 7:40 AM 

To: Emma 

Subject: Home today? 

Dearest Emma, 

It's Sunday morning. I've been up since 5:30. 1 walked 
laps around the nursing station for an hour. They checked my 
pulse, temperature, and blood pressure, and they sent some 
blood tests to the lab. The one I care about the most is the 
methotrexate level — if it's under 50, 1 get to go home today. I 
can't believe that this may be my last admission — #5 of 5 
admissions, and chemo #15 out of 16. 

Q came to visit yesterday. She brought me the book On 
Chesil Beach by Ian McEwan, and showed me some new digital 
photos of Nick and Ben. After Q left, Dad came. It was a little 
after 4. He said he had a wonderful time visiting you at camp. 
We watched a rerun of Monk on the hospital TV and took a nap 
together. Nate went out with his friends and I didn't see him 

I finished the fabulous book I was reading: Eat, Pray, 
Love by Elizabeth Gilbert. It's about a woman who goes 
through a bitter divorce and depression and then takes a three- 
part trip, to Italy (to discover the pleasures of the body — "eat"), 
India (to discover spiritual pleasures — "pray"), and Indonesia 
(to find the balance between the two — "love"). I loved it! When 
she goes to Italy, she describes all the delicious food she eats. 
She would get to a town and ask, "Where do you get the best 
food in this town?" And when she went to a restaurant, she 
would say, "Don't bring me the menu — just bring me the best 
meal you can cook." Her food descriptions make your mouth 



water. Definitely something you want to read near a stocked 
refrigerator or take-out menus. The story is genuine and the 
writing riveting. 

I've just got 1 1 days left, Emma. And I'll see you at 
camp a week from today, in seven days. I love you so much. 


Sun Moon Stars 


From: Laura 

Sent: Saturday, July 21, 2007 5:58 AM 

To: Emma 

Subject: Tomorrow 

Dearest Emma, 

It's Saturday morning at almost 6 am, and I'm writing to 
you on my laptop. The boys are still asleep. It looks like another 
beautiful day. I have no plans for the day except resting. 

Emma, I have five more days left until I'm done with 
chemo! And the countdown continues. I can't wait until it's 
over. I also can't wait until I see you tomorrow — Dad and I are 
taking you out to a delicious lunch! And I'm going to give you 
a great big hug. I love you very much. 

Much love 
Sun Moon Stars 



From: Laura 

Sent: Thursday, July 26, 2007 9:12 PM 

To: Emma 

Subject: Finale 

Dearest Emma, 

I'm DONE WITH CHEMO!! !!!!!!!!!!!!!!!!!!!!!!!!!!!! 

The pre-celebration started yesterday. I ordered 2 dozen 
rainbow-colored balloons in various shapes (stars, hearts, etc.) 
and 1 dozen pink balloons, all made of Mylar instead of latex 
(because some people have allergies to latex) to be delivered to 
the hospital yesterday afternoon. I ordered them from the 
Balloon Salloon, which is where my work friends had ordered 
the balloons we got for my birthday just as I was beginning 
chemo. Great place — Tiffany, the balloon expert, was very 
helpful, and when you're on hold you get to listen to a great 
song that goes "Let's go sail away in my beautiful balloon," 
which I have loved since I was a kid. 

For an extra 50 cents per balloon, you can get a special 
treatment that makes the balloons stay on the ceiling for a week 
instead of a day. When I told them I'm getting the balloons to 
celebrate the end of chemo, Tiffany said that they would throw 
in the treatment for free (that may be the last time I get to "play 
the cancer card!"). So yesterday these 3 dozen balloons were 
delivered to the Women's Office. I brought the 2 dozen 
rainbow-colored balloons in various shapes to Athena, our 
informal group for women faculty, to celebrate the last night 
before chemo. 

Bringing the balloons to the meeting was harder than I 
had predicted. Have you ever tried to get through a revolving 
door with two dozen helium-filled balloons? Let me tell you 
right now, it doesn't work. Luckily we found an alternative, 
non-revolving door. Then when we got to the Faculty Club, 



where Athena is held, we released the balloons. Unfortunately, 
when we did it, we were standing in a part of the room with a 
particularly high ceiling, and the balloons all flew way up to the 
ceiling, where we couldn't retrieve them. The tallest woman 
among us, Ann, stood on a chair with tongs and managed to 
retrieve several balloons, and we took them to a part of the 
room with lower ceilings, so we could reach them. 

The meeting was great. We celebrated three women's 
promotions. One of the women brought her mom, her two 
daughters, and the people who work with her in the office. We 
gave them each a bouquet of flowers. I told them I was 
celebrating the end of chemo. It was warm and supportive and 
wonderful. I got a lot of hugs. When I came home, Dad and 
Nate were here. Dad had ordered me some delicious fruit from 
Harry & David — cherries, plums, and peaches, which are my 

Today was the last day of chemo. I woke up around 6, 
but went back to sleep until 7. 1 showered and got dressed 
(Caribbean skirt, brown silk sleeveless Eileen Fisher tank, 
Monk hat) and went to check in at chemo. Then two hours in 
my office while they mixed the chemo. I got my favorite room, 
with windows, and had two neighbors — a woman named 
Georgina and a woman named Bella. My nurse was Beth. The 
chemo went in fine — no problems. At 1 :06 pm, I heard the three 
beeps of the pump that indicated that my Rituximab was in — 
the last of the chemo! They had to give me a little more IV fluid, 
and they disconnected me at 1 :36 pm. 

I gave balloons to Cindy, Beth, my neighbors in the 
chemo suite, the nurses and patients in the other chemo suite, 
the people at the front desk, Phil, and a few others. And then I 
came home. 

I had ordered an additional 50 helium balloons (latex — 
we're not allergic to latex at home and they're cheaper), in all 



different shades of pink, to be delivered to the apartment. When 
I got home, Dad, Nate, and the balloons were here. We released 
the balloons in the apartment, and they flew to the ceiling of the 
living room, with their long strings hanging down — just like at 
the beginning of chemo. I like the symmetry, starting and 
ending with the same celebration. We're going to do what we 
did before — liberate the balloons that lose helium from the 
terrace into the sky. Today one balloon had no string, so we 
liberated it — and off it went, and it was gone — and hopefully 
my cancer is gone too. 

I'll have post-chemo tests in a month. If the tests are 
good, I get maintained on a medicine called Rituximab, which 
I'll probably get once every two months intravenously as an 
outpatient. If the tests are bad, I get a bone marrow transplant. 
The tests in the middle of chemo were good, and hopefully 
these will be too. 

I'm going to take it easy for a few days. Next weekend 
we'll start packing for Nate's trip to Spain. And the three of us 
will spend a long weekend in Maine before you get home. 

Emma, it was so wonderful to see you this past Sunday 
and to hear about camp. I loved our lunch and trip to the mall — 
I'm excited about doing more serious shopping with you when 
you get home! And don't worry, I'll be off prednisone by then, 
so you don't have to worry that when I find shoes I like, that I 
will buy them in every color. 

Much Love Always 

Sun Moon Stars 

And Everything Beautiful in the Universe 




From: Laura 

Sent: Thursday, July 26, 2007 1 1 : 14 PM 

To: Jennifer 

Subject: Done with chemo! 

Dearest Jen, 

I know how busy you are with the baby, but this is just a 
quick note to share with you — today was my last day of chemo! 
The post-chemo work-up (CT, MRI, bone marrow) is in a 
month, and will determine the next steps. 

Kiss the kids for me, and let's talk soon. You call me — I 
don't want to violate the golden rule, Never Awaken a Sleeping 


From: Laura 

Sent: Friday, July 27, 2007 1:28 PM 

To: Cindy 

Subject: RE: You're gonna make it after all! 

Cindy — I'm singing along! I was so thrilled you joined 
me in chemo to release the balloons. It was so fitting for you to 
be there. You were my guardian angel through the worst of the 
chemo, so I'm glad you could be there for the best! 

Today when I took my walk I tied a pink balloon to my 
fanny pack (on the side; otherwise if I tied it in the back it 
would look like I have a large pink tail). I was curious to see 



how people on the boardwalk would respond. One guy with 
sunglasses who was running gave me a thumbs up, and I gave 
him a thumbs up in return; everyone else ignored it. Typical 
New Yorkers. I could walk down the boardwalk on fire and 
nobody would pay attention. Got to love this town. 


From: Laura 

Sent: Tuesday, July 31, 2007 4:48 AM 

To: Jennifer 

Subject: The Prednisone Diaries: Finale 

Dearest Jen, 

Today is my last day of prednisone! I had my final R- 
CHOP on Thursday, with 5 days of oral prednisone afterwards 
(Friday, Saturday, Sunday, Monday, Tuesday). Today's 
Tuesday, so that's it — "The Prednisone Diaries" finale! 

Update on the 50 helium-filled pink balloons I had 
delivered to my apartment at the end of chemo — David, Nate 
and I placed bets on how long the last balloon would be up on 
the ceiling. I guessed August 2, but they're almost all down 
now (mine might still be the closest bet — Nate and David 
picked August 3 and 4, respectively). Today Nate and I 
liberated some balloons off the terrace, and they soared into the 

It ain't over, Jen — the post-chemo work-up will be late 
August/early September. Rituximab or a bone marrow 
transplant. Come on, Rituximab! 




From: Laura 

Sent: Tuesday, July 31, 2007 6:00 PM 

To: Emma 

Subject: To Emma in Washington DC 

Dearest Emma, 

It's Tuesday night. Are you done or almost done with 
your Washington trip? Did you have a good time? 

Yesterday I worked a regular day, but today was lighter. 
I had to go to a doctor's appointment this morning for some 
blood tests and a shot (all of which were fine) and then I gave a 
noon seminar to new faculty members at my hospital on how to 
get promoted. 

After the seminar was done I got in a cab to go home 
and called Dad — and he was already at home. Can you 
imagine? We were both home by 2:00 in the afternoon! Carmen 
had already left for the day and Nate was out. We went up to the 
pool for a swim, read a little, and came downstairs, made a big 
salad with grilled chicken, and watched a jazz video on DVD — 
Art Blakey and the Jazz Messengers playing a bunch of songs 
including one that was really great called "Moanin'." 

Now I have something else to count down. It's July 31, 
and on August 10 you're done with camp. Ten more days until 
my beautiful Emma comes home. I love you so much, Emma. 

Much love 
Sun Moon Stars 



From: Laura 

Sent: Wednesday, August 1, 2007 4:31 AM 

To: Jennifer 

Subject: Getting together 

Hi Jen. I'm so excited that you're making a day trip to 
New York in a couple of weeks. August 18 is perfect! Can you 
come to my house for lunch, and I'll make gazpacho and get 
fresh bread? We can eat on the terrace if it's not too hot, and 
otherwise we can eat inside in the air conditioning. Let's talk 
and make a definite plan. 

David, Nate and I are going to Maine for a long 
weekend while Emma is still in camp. I used to go to camp in 
Maine when I was a kid and remember the rough wild beauty of 
the place. It will be great to relax and breathe. Emma gets home 
on August 10, and then Nate goes to Spain the next day. 


From: Laura 

Sent: Friday, August 31, 2007 10:07 AM 

To: Jennifer 

Subject: Post-treatment work-up 

Hi Jen. It was so wonderful to see you when you came 
to New York and to meet Benjamin! I'm glad you got to see 
Emma too. Nate's having a terrific time in Spain, and will be 
home soon. David and I are enjoying the last days of summer. 



This week I had my post-treatment work-up and the CT, 
MRI, and repeat bone marrow biopsies were negative! They 
said "NO EVIDENCE OF LYMPHOMA" three times. No bone 
marrow transplant — I'm thrilled! I'll get maintenance 
Rituximab for at least six months, and then they'll repeat the 
tests to confirm that I'm still in remission. The minute I found 
out, I called David at work, Nate in Spain, and Emma at home 
from my cell phone to tell them the good news. As I took my 
celebratory walk home on the boardwalk, I couldn't help 
dancing as Marvin Gaye and Tammi Terrell sang, "Ain't No 
Mountain High Enough." 

When I got home, I told Emma that I hope to be around 
to embarrass her for years to come. She said to me, "Mom, 
could you be around, but NOT embarrass me?" And I said, "Oh, 
no, honey, that's not possible. Moms have been embarrassing 
their teenage daughters since the dawn of time. We can't break 
with tradition." 



Chapter 14 
How to Cope with Cancer: Lists 

From: Laura 

Sent: Tuesday, September 04, 2007 1 1 :07 AM 

To: Jennifer 

Subject: Lists 

Hi Jen. Based on my experience as both a cancer doctor 
and a cancer patient, I've written lists of suggestions about how 
to cope with cancer. For individuals dealing with cancer and for 
their loved ones, I have a general list of 1 8 items — in Hebrew, 
the symbol for 1 8 is "Chai," which means life. I also give a list 
of reading material, music, and other activities that may help 
those with cancer. In addition, I provide a list of suggestions for 
doctors caring for individuals with cancer. The lists follow. 

List 1: For Those with Cancer & Their Loved Ones 

1 . Reach out to your friends. 

2. It's OK to cry, but do so <20 minutes/day. 

3. Ask for what you need. Be your own advocate. 

4. Cancer is the best excuse you'll ever have — use it! "Play 
the cancer card." 

5. Get your priorities straight. 

6. Keep your sense of humor. 

7. Find silver linings. Don't look at this as losing your hair, 
but rather as an opportunity to get new hats! 

8. Get doctors you trust and listen to their advice. 



9. Be sensitive to your family. Tell them that it's OK to 
talk about it. It can be harder on them than on you. 

10. Get in shape, physically and mentally. Save your energy 
for the fight. Don't sweat the small stuff or anticipate 
too much in advance. Take it "bird by bird." 

1 1 . Use your experience to help others. 

12. Bring your own anesthesia, like ethyl chloride spray and 
Emla cream. Ask your doctor for a prescription. If you 
need lots of IV chemo, strongly consider getting a port 
(catheter) before treatment — it will spare you multiple 
needle sticks. 

13. Go iPod!! Have your partner, friends, family, and/or 
kids put songs on it. Listen during chemo. Read books. 
Curl up with family & friends, and watch DVDs (try 
Monk — it's great and each episode lasts an hour). 

14. Discover your inner Zen. You will have to wait a lot. 
Pretend each doctor's visit is a trip to the airport. 

15. Savor celebrations. It's not all about the cancer! 

1 6. Ask people to pray for you. Have all denominations 
covered. Befriend a Buddhist. 

17. Write. 

18. Hope. 



List 2: Suggested Reading 


Bauby JD. The Diving Bell and the Butterfly: A Memoir of Life 
in Death. New York, NY: Vintage Books, Random House, Inc.; 

Bolte-Taylor, J. My Stroke of Insight: A Brain Scientist 's 
Personal Journey. New York, NY: Viking Press; 2008 
(Especially helpful are Chapter 20, Tending the Garden, and 
Appendix B, Forty Things I Needed the Most.) 

Genova, L. Still Alice. New York, NY: Pocket Books, Simon & 
Schuster, Inc.; 2009 

Gould SJ. Full House: The Spread of Excellence from Plato to 
Darwin. New York, NY: Three Rivers Press; 1996 (especially 
Chapter 4, Case One: A Personal Story, Where any measure of 
central tendency acts as a harmful abstraction, and variation 
stands out as the only meaningful reality, pp 45-56; note Figure 
7 on page 55) 

Holland J and Lewis, S. The Human Side of Cancer: Living 
with Hope, Coping with Uncertainty. New York, NY: 
HarperCollins Publishers; 2000 

Pausch R with Zaslow G. The Last Lecture. New York, NY: 
Hyperion Books; 2008 ("We cannot change the cards we're 
dealt, just how we play the hand.") Also, see his amazing 
YouTube video at :::: UTF- 
8&rlz=lT4SUNA enUS267US273&q=randy+pausch 




Cunningham M. The Hours. New York, NY: Picador; 2000 

Daniell E. Every Other Thursday: Stories and Strategies from 
Successful Women Scientists. New Haven, CT: Yale University 
Press; 2008 

Gilbert E. Eat, Pray, Love: One Woman 's Search for 
Everything Across Italy, India, and Indonesia. New York, NY: 
Penguin Books; 2007 

Kellaway L and Lukes M. Who Moved My Blackberry? New 
York, NY: Hyperion; 2006 

Lamott A. Bird by Bird: Some Instructions on Writing and Life. 
New York, NY: Anchor Books, Random House; 1995 

Niles B. New York's 50 Best Places to Take Tea. New York, 
NY: Universe Publishing; 2008 (If you're not a New Yorker, 
get a similar book for your home town, and go!) 

Obama B. The Audacity of Hope: Thoughts on Reclaiming the 
American Dream. New York, NY: Crown Publishers, Random 
House; 2006 

Patchett A. Bel Canto. New York, NY: HarperCollins; 2001 

Quindlen A. A Short Guide to a Happy Life. New York, NY: 
Random House; 2000 




Carver R. Where I'm Calling From. New York, NY: Vintage 
Contemporaries; 1989 (or anything else by him) 

Hemingway E. The Complete Short Stories of Ernest 
Hemingway. New York, NY: Scribner Paperback Fiction, 
Simon & Schuster; 1998 (or anything else by him) 

Klass P. Love and Modern Medicine. New York, NY: Houghton 
Mifflin; 2001 (or anything else by her) 

Lahiri, Jhumpa. Unaccustomed Earth. New York, NY: Alfred 
A. Knopf; 2008 (or anything else by her) 


Edson M. Wit. New York, NY: Dramatists Play Service; 1999 

Wasserstein W. Third. New York, NY: Dramatists Play Service 
(unpublished manuscript) 


Carver R. All of Us: The Collected Poems. New York, NY: 
Vintage; 2000 

Dickinson E. The Poems of Emily Dickinson: Reading Edition. 
Belknap Press; 2005 



List 3: Suggested Music, Listening, & Viewing 


The Beach Boys Greatest Hits 

The Beatles 

George Benson 

Joe Cocker, With a Little Help From My Friends 

Sam Cooke, Portrait of a Legend 

Feeling Groovy (Patrick and Eugene) 

Aretha Franklin 

Marvin Gaye, The Love Songs (& Ain't No Mountain High 

Al Green (Greatest Hits) 
The Jackson 5, I'll Be There 

Norah Jones, Come Away With Me (or anything else she sings) 
Ben E. King, Stand By Me 

Carole King: Tapestry, Music, Rhymes & Reasons 
Bette Midler: The Divine Miss M 
Moon River 

Diana Ross and the Supremes 
Sade, Stronger than Pride 
Frank Sinatra 

Buffalo Springfield, For What It's Worth 
James Taylor (Best of James Taylor) 
Tears for Fears, Shout 
The Temptations (My Girl, The Way You Do The Things 

You Do, anything else) 
Three Dog Night (especially One, Eli's Coming, Joy to the 

Stevie Wonder, At the Close of a Century 




Bach (anything he wrote) 

Bach: Hilary Hahn plays Bach 

Bach: Piano Concertos, Partitas, Preludes and Fugues, 2- and 

3 -part Inventions, Goldberg Variations, played by Glenn 

Bach Six Suites for Unaccompanied Cello, played by Yo-Yo 

Ma (or anything else played by him) 
Beethoven Symphonies (eg #7 2 nd movement & #9) 
Beethoven piano sonatas, piano concertos 
Brahms Sonatas for Cello and Piano, played by Yo-Yo Ma & 

Emanuel Ax 
Brahms Sonatas for Clarinet and Piano, Clarinet Trio 
Chopin Nocturnes 
Elgar Cello Concerto by Jacqueline Du Pre (or anything else 

played by her) 
Mozart Piano Concertos, played by Murray Perahia 
Mozart Piano Sonatas, Sonatas for 1 Piano 4 Hands, Sonatas 

for 2 Pianos 
Mozart Violin Sonatas, played by Hilary Hahn 
Poulenc Clarinet Sonata, Flute Sonata 
Schubert Impromptus, Fantastia in F Minor for two pianos, 

Trout Quintet, Unfinished Symphony 
Schumann Kreisleriana, Fantasiestucke 
Schumann: Music & the Mind, Vol I (DVD), The Life & 

Works of Robert Schumann, by Dr. Richard Kogan 




Louis Armstrong (especially Louis Armstrong Meets Oscar 

Peterson, Louis Armstrong & Ella Fitzgerald) 
Chet Baker 
Joanne Brackeen 
Dee Dee Bridgewater 
Betty Carter 

Ray Charles (especially Georgia on My Mind) 
John Coltrane (especially My Favorite Things, My One & 

Only Love) 
Eddie Daniels: To Bird With Love 
Miles Davis, Kind of Blue 

Eliane Elias, Something for You (sings and plays Bill Evans) 
Bill Evans; Bill Evans & Jim Hall 
Ella Fitzgerald 
Getz/Gilberto (especially The Girl From Ipanema, 

Dexter Gordon 
Jim Hall, Concierto 
Herbie Hancock, Speak Like a Child 
Keith Jarrett (At the Deer Head Inn or any trio) 
Nino Josele, Paz (jazz guitar; playing music of Bill Evans) 
Jeremy Pelt 

Houston Person (especially It Might As Well Be Spring) 
Oscar Peterson 
Esperanza Spalding (fabulous bassist/singer/composer): Junjo, 

Toots Theilemans 
Sarah Vaughan 

Ben Webster (especially Ben Webster Meets Oscar Peterson) 
Joe Williams 
Cassandra Wilson (Blue Skies, Standards) 




A Chorus Line 




In the Heights 

Mo' Better Blues 


Singin' in the Rain 

Spring Awakening 



The Colbert Report with Stephen Colbert 

The Daily Show with Jon Stewart 

Hitchcock movies 


Project Runway 

The Rachel Maddow Show 

Sports Night 

West Wing 

Woody Allen movies 


George Carlin 



List 4: Advice to Doctors 

1 . The person you are treating is not just a "patient," 
but an individual, with a life, a brain, and a heart. 

2. Listen to those you treat and their loved ones. 

3. Give essential information. Be honest, and don't 
abolish hope. 

4. Be kind and respectful. Let the people in your care 
keep their dignity. 

5. Encourage those for whom you care to deal with 
each item as it arises, and not to anticipate several 
steps in advance. Understand that this is easier said 
than done. 

6. Realize what you do and don't know. If you don't 
know something, learn it or ask someone who does. 

7. Treat as you would want to be treated. The white 
coat doesn't make you immune. One day, you may 
be on the other side. 

8. Relieve pain. Be generous with anesthesia. 

9. Alleviate anxiety and fear. Cancer can be scary. 

10. Cure us or put us into remission, if you can. If not, 
help each of us live what we perceive to be the best 
life possible. 

I'd appreciate any edits. 





From: Laura 

Sent: Thursday, March 20, 2008 3:47 am 

To: Jennifer 

Subject: Looking back 

Hi Jen. I haven't written you a middle-of-the-night email 
for a long time. So many stories to tell! 

It's been a tough six months since I went into remission. 
I was exhausted and went into a depression that lasted for 
several months. While you're getting chemo, you're highly 
focused and the adrenaline is pumping. All of your energy is 
geared to fighting cancer, which has got to be one of the world's 
best enemies. There's no time or energy to reflect. The agenda 
is simple: survival. You hang on for dear life. Then the battle 
ends, and some people think that once the cancer is in remission, 
you're done, and you can go back to business as usual. They're 
wrong. Surviving cancer is like weathering Hurricane Katrina. 
After the storm has passed, it takes time to survey the damage 
and rebuild. 

The post-chemo depression took me by surprise. It's 
hard to accept that your body isn't the same as it used to be. 
Before cancer, I had been highly energetic: Picture the 
Eveready Bunny ("it keeps going and going...") in the hospital, 
juggling multiple activities at once, and that was me. After 
chemo, I had to learn to live with fatigue and with a new 
cognitive style: I could no longer multi-task. I've since spoken 
to lots of cancer survivors, who tell me that diminished multi- 



tasking ability after chemo is fairly common. Changes in your 
body or persona can be experienced as a loss, and as with any 
loss, you may grieve. It helped to view the depression as a 
foggy beach, with the sun hidden behind it; I knew that 
somewhere in there the sun was shining, and that eventually I'd 
find it. I also used my hospital's survivorship program when I 
could, although sometimes it wasn't possible — for example, one 
night they had a lecture on "Coping with Fatigue after Cancer 
Treatment," but I was too tired to go! 

The chemo part of my treatment is over, but I'm 
continuing on maintenance therapy for at least two years. Once 
every two months, I get an infusion of Rituximab, the 
monoclonal antibody against B lymphocytes that had been the 
R of the R-CHOP regimen that I received during chemo. I've 
kept the port in my chest, so they can give the Rituximab 
through that. Because the monoclonal antibody treatment 
compromises my immune system, I continue to take a slew of 
pills to prevent infection. The chemo put me into menopause, so 
I take hormone replacement — until I started taking it, I was 
constantly throwing open the windows on freezing cold days, 
and David would have to go put on a warm pair of socks. 

A surgeon I know once told me that as a working mom, 
you juggle three things: (1) work, (2) family, and (3) taking care 
of yourself; at any given time, you get to focus on two out of 
three. Item (3) is especially challenging when you're dealing 
with ongoing treatment and the aftermath of chemo. To 
accommodate my body, I now work four days a week: two in 
the Women's Office (Mondays and Wednesdays) and two in 
Radiology (Tuesdays and Fridays). Friday is the day I see 
patients and do procedures. Thursday is my day off and it fills 
easily, with doctors' appointments, music, reading, tea with Q, 
and naps. I sleep for most of the weekend to recover from doing 
clinical work on Fridays. 



Having cancer changes you in unexpected ways. I 
selectively use my experience to help patients. Sometimes if I 
tell a patient that she has cancer and she takes it hard, I tell her 
that I'm a cancer survivor and share with her the survival skills 
I learned, including finding your friends, asking for what you 
want, getting an iPod, and "playing the cancer card." I also give 
lots more anesthesia for procedures than I did before. It's odd 
how when I was first diagnosed, I felt like a doctor pretending 
to be a patient. Now, sometimes I feel like a patient pretending 
to be a doctor. The other day, I did a biopsy on a woman with a 
breast lump, and when I signed the consent, I signed as the 

Sometimes friends ask me how I stayed so calm during 
chemo — why didn't I "lose it" more often? (Funny, my super, 
Jesus, never asks me that.) The survival techniques I described 
in the lists I sent you helped a lot. In addition, cancer gave me 
something I hadn't ever given myself — a break. I'd always been 
an intense workaholic. Having cancer forced me to slow down 
and look around, and once I looked around, I liked what I saw. 
If I had to have cancer, I'm glad that it happened when both of 
my kids were still at home so I could spend time with them. I 
can't redo the past, but I can use my experience to attain a better 
balance in the rest of my life and to help others find balance in 
theirs. Now that's a real silver lining. 

After I finished treatment, I spent several weeks cutting 
and pasting all of the emails I had written about my experience 
(mostly to you) into a Word document for the book I'd planned, 
but when I finally put it together, the book was 95 1 pages long. 
The idea of cutting that massive tome into a book of 
manageable size was daunting. The information was so raw and 
fresh that I didn't feel I could cut any of it — it was all too 
important — so I put it away for awhile. Now, six months later, 
I'm still exhausted but the fog of depression has lifted. I started 



thinking that Vd like to turn the book into a series of 
interconnected short stories, and that it would help me 
accomplish that if I met other writers off whom to bounce ideas. 

Nate went online with me to look for writing classes. He 
found the Gotham Writers' Workshop, a funky New York 
group that has writing classes all over the city. I found a course 
that meets on Wednesday nights on the Upper East Side, about 
halfway between work and my house. I thought that would be 
perfect, especially since I'm in the Women's Office on 
Wednesdays so I shouldn't be as exhausted as after a day of 
biopsies. Also, I don't work on Thursdays, so if I'm inspired by 
the workshop on Wednesday night, I have the next day to write. 

The class started in early March, and I love it. The 
teacher, Tania, got her Master's at Columbia, and will publish 
her first novel in the fall. There are 12 students, six women and 
six men. It's a diverse crowd, ranging from a kid Nate's age to a 
woman about to retire. Other students include a TV producer, a 
guy who writes advertising copy, a woman who teaches high 
school English, and a couple of people who work at Barnes & 
Noble. Another student is a woman in her twenties who takes 
pole dancing (when I told Emma the story, she rolled her eyes 
and said that pole dancing is popular; many celebrities do it for 
exercise. Who knew?). Most of the students want to write short 
stories but one man is working on a novel. 

The best part of class is called "Booth." When it's your 
turn for booth, you have to give copies of 15-25 pages of 
original writing to all class participants. They take it home to 
read and give comments the next week. First, we go around the 
room and everyone gives a positive comment, and then we go 
around again and everyone gives an "improvement" comment. 
They needed a volunteer for week one, so I raised my hand. I 
had already decided to write about the hats Emma and I went to 
buy at the beginning of chemo. I thought I'd tell it from a third 



person point of view, lulling the reader with lush language 
describing the hats' colors and fabrics, and not revealing until 
the end that the woman is buying the hats because she is about 
to start chemo and lose her hair (and possibly her life). A 
surprise ending, like in "The Necklace" by Guy de Maupassant. 

I went to the computer and opened my file marked 
"Book" and browsed through it for the first time since the fall. 
Amazing — what had looked so daunting to me before now 
seems absolutely manageable. It stands together as a book, and 
I'm going to write the book. When I look at the first draft 
carefully I see that sometimes I tell the same story several times 
to different people in different emails, so often I have multiple 
drafts of the same material. The redundancy makes it easier to 
trim and lets me choose the best elements of the story to 
combine into a cohesive whole. So when it's my turn for Booth, 
I bring in 15-25 pages of the book. 

Since I've resumed writing, I've been waking up again 
from 3-5 am, now without the help of steroids. Maybe in 
writing the book I'm putting myself back into the frame of mind 
that I had during treatment, and maybe that will help me 
recreate the story. It will be a huge job. Even with the distance 
of six months, some of the stuff seems so precious that it's hard 
to cut, even if it doesn't serve the story. A writing teacher 
named Carol Winkelman once told me that when you're editing, 
sometimes you have to "slaughter your darlings," meaning cut 
something you wrote that's close to your heart. She suggested 
that rather than deleting, you simply cut and paste the section 
you're omitting into another file (I call mine "out-takes"). This 
technique makes it easier to edit because material isn't being 
destroyed, just relocated. Sometimes I think that my father 
wanted me to be a doctor and a writer — he used to tell me that 
Chekhov did both. 



It seems appropriate that the end of my book is written 
about a year after treatment began. I'm spending more time with 
my family, and they're doing great. Nate will hear from 
colleges soon, and will graduate from high school in two 
months. Emma loves art and writing and is planning what she'll 
do this summer. David and I go to jazz clubs, and love to 
discover new musicians. My hair is growing back; last week I 
had my first bad hair day, and it was glorious! For spring break, 
the four of us are going to Sedona, Arizona, where we'll hike 
the red rocks together. 

My cancer experience reminds me of the quote below 
from the great book, The Hours, by Michael Cunningham. Have 
you read it? 

"Yes, Clarissa thinks, it's time for the day to be over. We 
throw our parties; we abandon our families to live alone in 
Canada; we struggle to write books that do not change the 
world, despite our gifts and our unstinting efforts, our most 
extravagant hopes. We live our lives, do whatever we do, and 
then we sleep — it's as simple and ordinary as that. A few jump 
out of windows or drown themselves or take pills; more die by 
accident; and most of us, the vast majority, are slowly devoured 
by some disease or, if we're very fortunate, by time itself. 
There's just this for consolation: an hour here or there when 
our lives seem, against all odds and expectations, to burst open 
and give us everything we've ever imagined, even though 
everyone but children (and perhaps even they) knows these 
hours will inevitably be followed by others, far darker and more 
difficult. Still, we cherish the city, the morning; we hope, more 
than anything, for more. Heaven only knows why we love it 

Jen, I can't thank you enough for being my "gentle 
reader" through all of this. Parts of it were very scary, especially 
in the beginning, and it helped that no matter what was going on 



I could write to you and I knew that you would read it, care, and 
respond. Once I had one dose of all the different kinds of chemo 
I wasn't so scared, and after the mid-chemo re-staging tests 
were OK I felt I could conquer the world. And you were always 
there, through all of it. 

Being able to write to you about my cancer helped me 
for so many reasons. I got to express myself, to understand how 
I felt by writing about it, and to create something to leave 
behind even if I didn't make the 50/50 shot. Also, writing this 
book allowed me to feel that my cancer served a purpose: I 
produced something that might help others, either by offering 
suggestions on how to deal with cancer or by simply providing 
distraction during those long days of treatment and recovery. 
And I hope I can hold on to what I learned about savoring 
celebrations, even if the cancer is gone for good. 

I wonder — what's next? 



Characters (in alphabetical order) 

Cindy: Friend of Laura's. She is the Chief Technologist in 
Breast Imaging at the hospital where Laura works, and she and 
Laura have known each other for 17 years. 

David: Laura's husband. When the book opens, Laura and 
David have been married for 24 years. David is a doctor 
specializing in Infectious Diseases, a native New Yorker who 
loves jazz, and an incredible husband and father. 

Ellen: Author and former scientific consultant who wrote the 
book "Every Other Thursday" about a group of women who 
meet every two weeks to give each other mutual support and 
guidance. She encourages Laura to write about her cancer 

Emma: Laura's daughter. When the book opens she is 14, a 
freshman in high school. She is full of joy and has an innate 
sense of style. She loves art and writing. 

Gerald: A physician-scientist at Memorial who makes 
discoveries in the lab and applies them to developing new, 
targeted anti-cancer drugs. 

Jennifer: Friend of Laura's, to whom most of the emails in the 
book are directed. Jennifer and Laura met in a chamber music 
class in New York City ten years ago and keep in touch mostly 
by email. Jennifer is a child psychologist who lives with her 
husband and daughter in Philadelphia. She is also a fabulous 



Jimmie: A psychiatrist and former Chair of the Department of 
Psychiatry at Laura's hospital. 

Laura: A doctor at a cancer hospital who develops cancer. 
Laura is married to David and has two children, Nate and 

Mark: Laura's brilliant and kind neurosurgeon, originally a boy 
from Tennessee who couldn't sing. 

Maureen: Friend of Laura's, also a doctor at the cancer hospital 
where Laura works. Maureen has had cancer and fears nothing. 

Mel: A breast surgeon in California, who has known Laura for 
years through meetings and publications. 

Memorial Hospital/Memorial Sloan-Kettering Cancer 
Center, New York, NY: The finest cancer hospital in the 
world, where Laura has been a doctor and, at the beginning of 
the book, becomes a patient. 

Mike: A breast pathologist in California who is a friend of 
Laura's. In his spare time, Mike participates in Triathlons. He is 
of Greek descent, an expert in ichthyology (the study of fish), 
and a friend and scientific collaborator of Mel's. 

Monique (aka "Q"): Friend and neighbor of Laura and her 
family. She and Laura met in the park when their oldest 
children were babies and have been close ever since. 

Nate: Laura's son. When the book opens he is 17, a high school 
junior applying to college. Nate likes community service, 
teaching, and writing. 



Phil: Laura's oncologist, one of the best lymphoma doctors in 
the world. He saves lives. 

Sam: Laura's neurologist, an expert in malignancies of the 
nervous system. 

Terri: A doctor at Laura's hospital specializing in medical 
oncology. In addition to caring for patients, she creates film 
documentaries about cancer. 


Glossary of Medical Terms 

Anesthesia: Numbing medicine. Anesthesia can be local (at a 
specific site, either by injection, spray, or cream), with the 
patient awake, or general (administered intravenously or by 
inhalation), in which the patient is generally asleep and 
breathing is assisted by a respirator or ventilator (breathing 

Biopsy: Taking a sample of tissue with a needle or with surgery 
to send to the pathology laboratory so it can be examined under 
the microscope to determine if cancer is present. 

Bone marrow: The site of development of blood cells, 
including red blood cells that carry oxygen in the blood, white 
blood cells that fight infection, and platelets that help the blood 
clot. In a bone marrow biopsy, a sample of bone marrow is 
removed, usually from the pelvis, to determine if malignant 
cells are present. 

Catheter: A small tube that allows access to a particular part of 
the body. These may be placed through the skin. 

Chemotherapy: Strong medication to kill cancer cells. Most 
chemotherapy works by killing rapidly dividing cells. 
Unfortunately, some normal cells divide rapidly, such as the 
cells in the bone marrow responsible for making blood cells. 

Cerebrospinal fluid (CSF): The fluid surrounding the brain 
and spinal cord. 

Cytology: Analysis of cells under the microscope. 



Fingerstick: A method of obtaining blood for a blood test by 
sticking a small needle in a fingertip and obtaining a few drops 
of blood to put on a glass slide. 

Intrathecal: Adjective: a route of administration for medication 
(such as chemotherapy) directly into the cerebrospinal fluid 
(CSF), the fluid around the brain and spinal cord. Intrathecal 
medication can be injected by performing a lumbar puncture 
(LP; also known as a spinal tap), a procedure in which a needle 
is inserted into the back to take fluid from around the spinal 
cord, or by using an Omaya, a sterile reservoir and tube that is 
implanted neurosurgically into the head. 

Intravenous (IV): Adjective: a route of administration into a 
blood vessel (vein) of fluids, medication, or blood products. 
Noun: a small plastic tube placed into a vein (blood vessel) to 
administer the above items. 

Leukovorin rescue: After administration of methotrexate, 
which is toxic chemotherapy, the leukovorin "rescue" involves 
repeated doses of an intravenous medication called leucovorin 
which helps combat the toxic effects of methotrexate. 

Lumbar puncture (LP): a procedure in which a needle is 
inserted usually into the back between the third and fourth 
lumbar vertebrae (back bones) into the sac of fluid around the 
spinal cord to remove cerebrospinal fluid (CSF), the fluid 
around the spinal cord and brain. Synonym: spinal tap. 

Lymph nodes: "Glands" containing lymphocytes, a type of 
white blood cell that participates in defending the body from 
infection. Lymph nodes can become enlarged in infections, 
inflammatory conditions, and malignant tumors. 



Lymphocytes: A type of white blood cells that normally 
participate in defending the body from infection. There are 
different types of lymphocytes (B cells and T cells) with 
specialized immune functions. In autoimmune diseases, the 
lymphocytes attack the body as if it were foreign. 

Lymphoma: A malignancy in which lymphocytes grow 
uncontrollably. Lymphoma can involve multiple body sites, 
including lymph nodes (the glands that swell up during 
infection), bone marrow (where new blood cells are produced), 
and other organs. 

Magnetic resonance imaging (MRI): An imaging test 
applicable to any part of the body. MRI uses strong magnetic 
fields to make signals that are displayed as images. 

Median survival: The amount of time for which half of the 
patients live less and half live more. A median survival of one 
year, for example, means that half of the patients live less than 
one year and half live more than one year. 

Mediport: A type of catheter (sterile plastic tube) that can be 
placed into a vein under sterile conditions to allow access for 
intravenous medications. The tip of the tube is in the vein, and 
the port or reservoir that is injected is placed underneath the 
skin. To access the Mediport, the nurse or doctor must pierce 
the skin with a needle. 

Methotrexate: A form of chemotherapy that attacks rapidly 
dividing cells. 



Monoclonal antibody: A pure population of proteins that 
attack a specific target, such as a particular cell surface marker 
in the body. Monoclonal antibodies are an example of "targeted 
therapy," in which the treatment is specifically designed to 
attack a particular target, rather than to cause generalized death 
of rapidly dividing cells. Because monoclonal antibodies are 
more specific, they generally have fewer side effects than 

Nadir: In general parlance, "nadir" means the lowest point 
(opposite of zenith, the highest point). In medicine, "nadir" 
refers to having an extremely low count of white blood cells 
responsible for fighting infection in the body. 

Neutropenia: Low count of neutrophils, a group of white blood 
cells that fight infection. 

Neutrophil: A type of white blood cell, also called a 
polymorphonuclear leukocyte or "poly," that fights infection. 

Omaya: A sterile tube that has its tip in the fluid around the 
brain (cerebrospinal fluid, or CSF). The Omaya must be placed 
neurosurgically by drilling a hole in the skull and inserting the 
catheter through brain tissue until it reaches one of the lateral 
ventricles, CSF-containing structures in the brain. 
Chemotherapy can be administered through the Omaya, and 
fluid can be removed from the Omaya ("Omaya tap") to 
determine if malignant cells are present. 

pH: A quantitative measure of acidity. A fluid pH of 7.0 is 
"neutral," <7.0 is "acidic," and >7.0 is "alkaline" or "basic." 
Oral bicarbonate can make the urine more alkaline. 



Port: The general term for a catheter (sterile plastic tube) 
placed into a vein to allow access for IV medications. A 
Mediport is a specific type of port. 

Prednisone: An oral steroid that can be used to treat a variety 
of diseases, including lymphomas. Prednisone can cause weight 
gain, sleep disturbances, and manic episodes. 

R-CHOP: An intravenous chemotherapy regimen used to treat 
some lymphomas. R is Rituximab, a monoclonal antibody 
directed against specific malignant B lymphocytes; C is 
cyclophosphamide; H is doxorubicin; O is vincristine 
(originally called Oncovin); and P is prednisone, an oral steroid. 

Remission: Control of active malignancy. Patients in remission 
may stay healthy or may redevelop malignancy in the future 

Stage IV: Disseminated malignancy. This is the most advanced 
stage of cancer, when sites other than the location of the index 
tumor are involved, and has the worst outcome. 

Targeted therapy: Anti-cancer treatment that specifically 
attacks malignant cells, without significant damage to normal 
cells. Hopefully, this approach will become available for many 
cancers, providing effective therapy with minimal side effects. 

Ventricles of the brain: Four fluid-filled structures in the brain 
that contain cerebrospinal fluid (CSF) and communicate with 
the CSF around the brain and spinal cord. The brain has two 
lateral ventricles (one on the right and one on the left) and two 
midline ventricles (the third and the fourth). 


LaVergne, TN USA 
07 October 2010 


780982 259009 

After 17 years as a doctor at Memorial Sloan-Kettering 
Cancer Center in New York, Dr. Laura Liberman was 
diagnosed with cancer and treated at her hospital. This 
memoir, organized as a collection of emails (an epistolary format with 
a modern twist), captures the surreal experience of being both a 
cancer doctor and a cancer patient, a scenario that resembles being in 
a play in which you know all the lines but you're reading the wrong 
part. Candid and humorous, / Signed as the Doctor will inspire the 
general reader, give insight to the 12 million people worldwide 
diagnosed with cancer each year, and inform doctors how to better 
care for individuals with cancer, all from the unique perspective of a 
cancer doctor surviving cancer. 

Original and fascinating." 

— Anna Fels, M.D., author, Necessary Dreams: 
Ambition in Women's Changing Lives 

Laura Liberman, M.D., is Director of 
Women Faculty Affairs and Attending 
Radiologist at Memorial Sloan-Kettering 
Cancer Center. She has written more than 
100 scientific papers, including pioneering 
studies of breast needle biopsy. She co-edited 
a best-selling medical textbook, Breast MRI: 
Diagnosis and Intervention, and has lectured 
around the world about cancer detection and 
diagnosis. In 2008, New York Magazine 
named her one of the Best Doctors of 
New York. 



9 780982"259009